Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 26NJ00533800 | NJ |
NPI | 1043598006 |
---|---|
Provider Name | Lauren M. Gaynor |
First Address | Northfield, NJ 08225-1440 |
Second Address | Northfield, NJ 08225-1440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2011 |
Last Update Date | 23/04/2019 |