Provider Demographics
NPI:1104592823
Name:AMAKOBE, MERCY KHASIALA
Entity type:Individual
Prefix:MISS
First Name:MERCY
Middle Name:KHASIALA
Last Name:AMAKOBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 N MADISON ST LOWR GROUND
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-1439
Mailing Address - Country:US
Mailing Address - Phone:302-252-7279
Mailing Address - Fax:
Practice Address - Street 1:915 N MADISON ST LOWR GROUND
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-1439
Practice Address - Country:US
Practice Address - Phone:302-252-7279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-22
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR238585163WC0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine