Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 26NNO8170200 | NJ |
NPI | 1033317979 |
---|---|
Provider Name | Ann Mahan |
First Address | Nutley, NJ 07110-2224 |
Second Address | Boca Raton, FL 33431-6424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 30/08/2019 |