Individual
MS. ELLEN JO FASANARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1114 GOFFLE RD, HAWTHORNE, NJ 07506-2014
(973) 427-7676
(973) 427-7476
Mailing address
1114 GOFFLE RD, HAWTHORNE, NJ 07506-2014
(973) 427-7676
(973) 427-7476
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
26NN08252000
NJ
Other
Enumeration date
02/16/2007
Last updated
07/08/2007
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