Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | NN048298 | NJ |
NPI | 1003846072 |
---|---|
Provider Name | Cathy Edson |
First Address | Woodbury, NJ 08096-2739 |
Second Address | Willingboro, NJ 08046-1110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 08/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8407703 | (05) | NJ |
P23283 | (02) |