Provider Demographics
NPI:1982817433
Name:GARETH, KATHLEEN (NP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:GARETH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 GRINNELL RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-5126
Mailing Address - Country:US
Mailing Address - Phone:302-478-5985
Mailing Address - Fax:302-478-5985
Practice Address - Street 1:1104 GRINNELL RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-5126
Practice Address - Country:US
Practice Address - Phone:302-478-5985
Practice Address - Fax:302-478-5985
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0000172363LF0000X
PAUP004049B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA116143LNHMedicare PIN
PA116143Medicare PIN