Provider Demographics
NPI:1174358352
Name:DE TRINITY PM HEALTH
Entity type:Organization
Organization Name:DE TRINITY PM HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP, PMHNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADEBOLA
Authorized Official - Middle Name:RITA
Authorized Official - Last Name:USUAH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:302-339-2260
Mailing Address - Street 1:2300 PENNSYLVANIA AVE STE 3B
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-1333
Mailing Address - Country:US
Mailing Address - Phone:302-339-2260
Mailing Address - Fax:
Practice Address - Street 1:2300 PENNSYLVANIA AVE STE 3B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-1333
Practice Address - Country:US
Practice Address - Phone:302-339-2260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-05
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty