Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 26NN064583000 | NJ |
NPI | 1023054574 |
---|---|
Provider Name | Corinne Rock Malmberg |
First Address | Toms River, NJ 08755-6400 |
Second Address | Toms River, NJ 08755-6400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 13/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8069000 | (05) | NJ |
S90583 | (02) | NJ |