| Doctor Name: | THERESA SOUTAR |
| NPI Number: | 1790737963 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | R.N. APN-C |
| License Number: | 26N009304400 |
| Business Practice Address: | 1405 Chews Landing Rd Laurel Springs, NJ - 080212769 |
| Business Phone Number: | 8562276575 |
| Business Fax Number: | 8563749495 |
| Mailing Address: | 402 Lippincott Dr, MARLTON |
| State: | NJ |
| Postal Code: | 080534112 |
| Phone Number: | 8567823300 |
| Fax Number: | 8565048029 |
| NPI Enumeration Date: | 05/16/2006 |
| NPI Last Update Date: | 03/19/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 26N009304400 |
| 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: | |