Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 26NJ00698900 | NJ |
NPI | 1003357922 |
---|---|
Provider Name | Mr. Michael C Cadorette |
First Address | Memphis, TN 38103-5513 |
Second Address | Newark, NJ 07102-5323 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2017 |
Last Update Date | 19/08/2021 |