Individual
TRAN TO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
15000 MIDLANTIC DR, MOUNT LAUREL, NJ 08054-1573
(877) 388-2778
(856) 252-1100
Mailing address
1 DIAMOND HILL RD, BERKELEY HEIGHTS, NJ 07922-2104
(908) 273-4300
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
26NJ01183600
NJ
363LA2200X
Adult Health Nurse Practitioner
26NJ01183600
NJ
Other
Enumeration date
08/11/2021
Last updated
01/19/2024
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