Doctor Name: | MRS. MARIE CHANTALE LHERISSON |
NPI Number: | 1124364096 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | 26NJ00399300 |
Business Practice Address: | 31 Mountain Ave Cedar Knolls, NJ - 079271203 |
Business Phone Number: | 9732700626 |
Business Fax Number: | |
Mailing Address: | 31 Mountain Ave, CEDAR KNOLLS |
State: | NJ |
Postal Code: | 079271203 |
Phone Number: | 9732700626 |
Fax Number: | |
NPI Enumeration Date: | 12/21/2012 |
NPI Last Update Date: | 12/21/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 26NJ00399300 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |