Provider Demographics
NPI:1578703914
Name:DIMARCO, CHRISTINA L (APN)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:L
Last Name:DIMARCO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:L
Other - Last Name:PALERMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:252 CHAPMAN RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5438
Mailing Address - Country:US
Mailing Address - Phone:302-366-7665
Mailing Address - Fax:302-366-0734
Practice Address - Street 1:BUILDING B-86
Practice Address - Street 2:OMEGA PROFESSIONAL CENTER
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-6004
Practice Address - Country:US
Practice Address - Phone:302-366-7665
Practice Address - Fax:302-366-0734
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG0000482363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1578703914Medicaid
DE151162ZA7AMedicare PIN