Doctor Name: | COURTNEY ELIZABETH HENNELLY |
NPI Number: | 1265623763 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APN |
License Number: | 26NJ00345800 |
Business Practice Address: | 136 Mountainview Blvd Basking Ridge, NJ - 079203444 |
Business Phone Number: | 9085423500 |
Business Fax Number: | 9085423211 |
Mailing Address: | 136 Mountainview Blvd, BASKING RIDGE |
State: | NJ |
Postal Code: | 079203444 |
Phone Number: | 9085423500 |
Fax Number: | 9085423211 |
NPI Enumeration Date: | 08/08/2007 |
NPI Last Update Date: | 03/21/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 26NJ00345800 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NJ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |