Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | LB-0000256 | DE |
NPI | 1023378676 |
---|---|
Provider Name | Suzanne E Omrod |
First Address | Wyoming, DE 19934-9540 |
Second Address | Newark, DE 19713-3159 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2012 |
Last Update Date | 16/05/2012 |