Organization Name: | GARDEN STATE VISITING PRACTITIONERS |
NPI Number: | 1669743332 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DIANE WRIGHT (PRESIDENT) |
Mailing Address: | 1672 Miller Ave West Deptford |
State: | NJ US |
Postal Code: | 080863210 |
Phone Number: | 8566284785 |
Fax Number: | |
NPI Enumeration Date: | 01/26/2012 |
NPI Last Update Date: | 01/26/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | 26NJ00328900 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |