Provider Demographics
NPI:1679221915
Name:PEARSALL, DECARLA (BSN, RN, CMDCP, CGCP)
Entity Type:Individual
Prefix:
First Name:DECARLA
Middle Name:
Last Name:PEARSALL
Suffix:
Gender:F
Credentials:BSN, RN, CMDCP, CGCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 CONCORD BRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5264
Mailing Address - Country:US
Mailing Address - Phone:302-213-0477
Mailing Address - Fax:
Practice Address - Street 1:710 WILMINGTON RD STE F
Practice Address - Street 2:
Practice Address - City:HISTORIC NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-3685
Practice Address - Country:US
Practice Address - Phone:302-213-0477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0037155163WG0000X, 163WH0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health