Provider Demographics
NPI:1558987693
Name:WOMEN'S WELLNESS OF SOUTHERN DELAWARE, LLC
Entity Type:Organization
Organization Name:WOMEN'S WELLNESS OF SOUTHERN DELAWARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALER & BILLER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HAUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-943-7460
Mailing Address - Street 1:17015 OLD ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-4849
Mailing Address - Country:US
Mailing Address - Phone:302-943-7460
Mailing Address - Fax:
Practice Address - Street 1:17015 OLD ORCHARD RD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4849
Practice Address - Country:US
Practice Address - Phone:302-943-7460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty