Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | MD425064 | PA |
Y | 207R00000X | Internist | 25MA04668200 | NJ |
Y | 111NI0900X | Internist | 25MA04668200 | NJ |
N | 207R00000X | Internist | MD425064 | PA |
N | 111NI0900X | Internist | MD425064 | PA |
N | 207RA0401X | Internist - Addiction Medicine | 25MA04668200 | NJ |
NPI | 1619190089 |
---|---|
Provider Name | Dr. Hazel Ann Nurse |
First Address | Camden, NJ 08103 |
Second Address | Camden, NJ 08103-1461 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 18/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1441400 | (05) | NJ |