Provider Demographics
NPI:1396508990
Name:WILLE, GINGER RENEE (CRNP)
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:RENEE
Last Name:WILLE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31775 DUANE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19945-2828
Mailing Address - Country:US
Mailing Address - Phone:144-366-8256
Mailing Address - Fax:
Practice Address - Street 1:9950 MAIN ST
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-3281
Practice Address - Country:US
Practice Address - Phone:443-668-2563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0012606363L00000X
MDAC006237363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner