# NURSE PRACTITIONER PROFESSIONAL RESOURCES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558516260
- **Authorized official:** MESHELL GLASGOW MANSOR APN (OWNER)
- **Authorized official phone:** (856) 885-4579

## Contact information

- **Practice address:** 4361 ROUTE 42, BLACKWOOD, NJ 08012-1794
- **Practice address phone:** (856) 885-4579
- **Practice address fax:** (856) 728-3513
- **Mailing address:** 202 CABOT CT, DEPTFORD, NJ 08096-5114
- **Mailing address phone:** (856) 669-8488
- **Mailing address fax:** (856) 513-1377

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | 26NJ00097200 | NJ | Yes |

## Other

- **Enumeration date:** 11/21/2008
- **Last updated:** 10/26/2021