Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | LB-0000204 | DE |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | LB-0000204 | DE |
NPI | 1497936652 |
---|---|
Provider Name | Mr. Timothy James Eden |
First Address | Newark, DE 19713-2049 |
Second Address | Wilmington, DE 19805-4917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2007 |
Last Update Date | 17/03/2018 |