Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | NR74702 | NJ |
NPI | 1023219292 |
---|---|
Provider Name | Mr. Jacqueline Elizabeth Fearon-Clarke |
First Address | Morristown, NJ 07960-6092 |
Second Address | Morristown, NJ 07960-6092 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 22/09/2008 |