Provider Demographics
NPI:1659799302
Name:VISCOUNT, DINA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:DINA
Middle Name:
Last Name:VISCOUNT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CENTURIAN DR STE 312
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2127
Mailing Address - Country:US
Mailing Address - Phone:302-319-5680
Mailing Address - Fax:302-319-5681
Practice Address - Street 1:1 CENTURIAN DR STE 312
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2127
Practice Address - Country:US
Practice Address - Phone:302-319-5680
Practice Address - Fax:302-319-5681
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-31
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELU-0000104364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health