Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 26NJ00996300 | NJ |
NPI | 1053959387 |
---|---|
Provider Name | Cassendra Lormil |
First Address | Old Bridge, NJ 08857-1832 |
Second Address | Old Bridge, NJ 08857-3084 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2019 |
Last Update Date | 20/04/2020 |