Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 26NJ00519300 | NJ |
NPI | 1003217480 |
---|---|
Provider Name | Mary Jo Donnell |
First Address | Browns Mills, NJ 08015-1705 |
Second Address | Browns Mills, NJ 08015-1705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2014 |
Last Update Date | 23/06/2015 |