Individual
MISS AMY LEE FARSIDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
310 CHRIS GAUPP DR STE 102, GALLOWAY, NJ 08205-4461
(609) 652-9933
Mailing address
4144 POST RD, VINELAND, NJ 08360-9313
(609) 319-2152
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
26NJ00433500
NJ
Other
Enumeration date
07/16/2015
Last updated
07/16/2015
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