Provider Demographics
NPI:1497420855
Name:FADER, WILLIAM (FNP)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:FADER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 ROSE HILL DR
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-2398
Mailing Address - Country:US
Mailing Address - Phone:302-897-0633
Mailing Address - Fax:
Practice Address - Street 1:701 FOULK RD STE 2E
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3733
Practice Address - Country:US
Practice Address - Phone:302-765-2345
Practice Address - Fax:302-691-7036
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2023-09-11
Deactivation Date:2023-06-17
Deactivation Code:
Reactivation Date:2023-07-05
Provider Licenses
StateLicense IDTaxonomies
DELG-0011708363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily