Provider Demographics
NPI:1851052468
Name:CONNECTDCARE FAMILY PRACTICE
Entity Type:Organization
Organization Name:CONNECTDCARE FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEMI
Authorized Official - Middle Name:F
Authorized Official - Last Name:OGUNWUSI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, MSN, FNP-BC
Authorized Official - Phone:302-387-5198
Mailing Address - Street 1:888 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-4148
Mailing Address - Country:US
Mailing Address - Phone:302-744-8438
Mailing Address - Fax:302-744-8425
Practice Address - Street 1:888 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4148
Practice Address - Country:US
Practice Address - Phone:302-744-8438
Practice Address - Fax:302-744-8425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-05
Last Update Date:2024-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE250699611Medicaid
DE250699628Medicaid