Provider Demographics
NPI:1508321415
Name:WEDDERBURN, JOYCE BEVERLY
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:BEVERLY
Last Name:WEDDERBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 ABRUZZI DR APT D-17
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:DE
Mailing Address - Zip Code:19938-4209
Mailing Address - Country:US
Mailing Address - Phone:302-465-4466
Mailing Address - Fax:
Practice Address - Street 1:147 ABRUZZI DR APT D-17
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:DE
Practice Address - Zip Code:19938-4209
Practice Address - Country:US
Practice Address - Phone:302-465-4466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0337924251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health