Provider Demographics
NPI:1700056223
Name:FONTAINE, GAYNEL (NP)
Entity Type:Individual
Prefix:MRS
First Name:GAYNEL
Middle Name:
Last Name:FONTAINE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GAYNEL
Other - Middle Name:
Other - Last Name:DANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HYGEIA DRIVE
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713
Mailing Address - Country:US
Mailing Address - Phone:302-655-6187
Mailing Address - Fax:
Practice Address - Street 1:2575 GLASGOW AVENUE
Practice Address - Street 2:HODGSON VO TECH
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702
Practice Address - Country:US
Practice Address - Phone:302-832-5400
Practice Address - Fax:302-832-5407
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL10031608163WS0200X
DELG-0000530363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WS0200XNursing Service ProvidersRegistered NurseSchool