Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 26NJ00521600 | NJ |
N | 363LA2200X | Nurse Practitioner - Adult Health | 26NJ00521600 | NJ |
N | 363LG0600X | Nurse Practitioner - Gerontology | 26NJ00521600 | NJ |
N | 363LP2300X | Nurse Practitioner - Primary Care | 26NJ00521600 | NJ |
NPI | 1023407574 |
---|---|
Provider Name | Miss Dorothy Vanslyke |
First Address | New Milford, NJ 07646 |
Second Address | New Milford, NJ 07646 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2015 |
Last Update Date | 21/01/2015 |