Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 26NJ01250100 | NJ |
NPI | 1063163111 |
---|---|
Provider Name | Mrs. Dionne Desiree Bademosi |
First Address | Pennsauken, NJ 08109-2377 |
Second Address | Moorestown, NJ 08057 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2022 |
Last Update Date | 11/01/2022 |