Doctor Name: | BEVERLY L DICERBO |
NPI Number: | 1720139033 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN,APN,C |
License Number: | 26NO09741700 |
Business Practice Address: | 210 Route Us 9 S Suite 106 Marmora, NJ - 082231200 |
Business Phone Number: | 6093907888 |
Business Fax Number: | 6093902614 |
Mailing Address: | 210 Route Us 9 S, Suite 106 MARMORA |
State: | NJ |
Postal Code: | 082231200 |
Phone Number: | 6093907888 |
Fax Number: | 6093902614 |
NPI Enumeration Date: | 01/15/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | 26NO09741700 |
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: |