| Doctor Name: | EMA NDI |
| NPI Number: | 1043649767 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | AC001200 |
| Business Practice Address: | 25 Forsythia Ln Bear, DE - 197016301 |
| Business Phone Number: | 3012374021 |
| Business Fax Number: | 3028366171 |
| Mailing Address: | 25 Forsythia Ln, BEAR |
| State: | DE |
| Postal Code: | 197016301 |
| Phone Number: | 3012374021 |
| Fax Number: | 3028366171 |
| NPI Enumeration Date: | 11/04/2013 |
| NPI Last Update Date: | 03/07/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AC001200 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MD |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |