Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 26NR07373700 | NJ |
NPI | 1073803060 |
---|---|
Provider Name | Jane Y Foreman |
First Address | Camden, NJ 08103-1438 |
Second Address | Camden, NJ 08103-1438 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2011 |
Last Update Date | 12/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
26NR07373700 | STATE LICENSE (01) | NJ |