Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 26NJ00561400 | NJ |
N | 363LC1500X | Nurse Practitioner - Community Health | 26NJ00561400 | NJ |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 26NJ00561400 | NJ |
N | 363LF0000X | Nurse Practitioner - Family Medicine | F339578-1 | NY |
N | 363LP2300X | Nurse Practitioner - Primary Care | 26NJ00561400 | NJ |
NPI | 1770966038 |
---|---|
Provider Name | Mary Tucker |
First Address | Paramus, NJ 07652-3607 |
Second Address | Paramus, NJ 07652-3607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2015 |
Last Update Date | 11/11/2016 |