Provider Demographics
NPI:1013944115
Name:WARDWELL, AMANDA (NP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:WARDWELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:HENCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4735 OGLETOWN STANTON RD STE 1208
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2089
Mailing Address - Country:US
Mailing Address - Phone:302-623-4055
Mailing Address - Fax:302-623-4056
Practice Address - Street 1:4735 OGLETOWN STANTON RD STE 1208
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2089
Practice Address - Country:US
Practice Address - Phone:302-623-4055
Practice Address - Fax:302-623-4056
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0032088163W00000X
PASP020110363L00000X
DELH-0000174363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse