Provider Demographics
NPI:1467711952
Name:ANTHONY-GUBITOSI, MAYUMI LEA (ANP)
Entity type:Individual
Prefix:
First Name:MAYUMI
Middle Name:LEA
Last Name:ANTHONY-GUBITOSI
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 CHRISTIANA RD STE 109
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-4248
Mailing Address - Country:US
Mailing Address - Phone:302-444-8156
Mailing Address - Fax:302-731-8158
Practice Address - Street 1:774 CHRISTIANA RD STE 109
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4248
Practice Address - Country:US
Practice Address - Phone:302-444-8156
Practice Address - Fax:302-731-8158
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELB-0000249363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health