Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 26NJ00095000 | NJ |
NPI | 1396184404 |
---|---|
Provider Name | Joelle Denise Hargraves |
First Address | Pomona, NJ 08240-9102 |
Second Address | Pomona, NJ 08240-9102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2013 |
Last Update Date | 21/06/2013 |