Provider Demographics
NPI:1578051819
Name:CREATIVE MEDICAL CONSULTING, LLC
Entity Type:Organization
Organization Name:CREATIVE MEDICAL CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:EVANS-MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, MSN, APRN
Authorized Official - Phone:302-312-6150
Mailing Address - Street 1:120 W MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-1040
Mailing Address - Country:US
Mailing Address - Phone:302-313-1411
Mailing Address - Fax:844-312-6150
Practice Address - Street 1:120 W MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1040
Practice Address - Country:US
Practice Address - Phone:302-313-1411
Practice Address - Fax:844-312-6150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0000781363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty