Doctor Name: | DR. COLLEEN R. WITHERELL |
NPI Number: | 1396836771 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | C10006211 |
Business Practice Address: | Nemours Pediatrics Jessup St. 1602 Jessup Street Wilmington, DE - 198024210 |
Business Phone Number: | 3025765050 |
Business Fax Number: | 3025765065 |
Mailing Address: | Po Box 191, Provider Enrollment Dept ROCKLAND |
State: | DE |
Postal Code: | 197320191 |
Phone Number: | 3026516212 |
Fax Number: | 3026514945 |
NPI Enumeration Date: | 09/28/2006 |
NPI Last Update Date: | 09/02/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | C10006211 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | DE |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |