Provider Demographics
NPI:1174923015
Name:WAINWRIGHT, AMANDA BERKEBILE (NP- C)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:BERKEBILE
Last Name:WAINWRIGHT
Suffix:
Gender:F
Credentials:NP- C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32427 LIGHTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:SELBYVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19975-3408
Mailing Address - Country:US
Mailing Address - Phone:443-424-6131
Mailing Address - Fax:302-616-0003
Practice Address - Street 1:32427 LIGHTHOUSE RD
Practice Address - Street 2:
Practice Address - City:SELBYVILLE
Practice Address - State:DE
Practice Address - Zip Code:19975-3408
Practice Address - Country:US
Practice Address - Phone:443-424-6131
Practice Address - Fax:302-616-0003
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0000780363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DELG-0000780OtherSTATE LICENSE
MDR181844OtherSTATE LICENSE