Provider Demographics
NPI:1518424100
Name:WIATROWSKI, GRACE A (FNP)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:A
Last Name:WIATROWSKI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 STANTON CHRISTIANA RD STE 304
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2135
Mailing Address - Country:US
Mailing Address - Phone:302-691-3800
Mailing Address - Fax:302-778-2250
Practice Address - Street 1:620 STANTON CHRISTIANA RD STE 304
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2135
Practice Address - Country:US
Practice Address - Phone:302-691-3800
Practice Address - Fax:302-778-2250
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-01
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0068173363LF0000X
CORN.1659143363LF0000X
COAPN.0994400-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000170555Medicaid