Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | NN81146 | NJ |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 26NO08114600 | NJ |
NPI | 1053355768 |
---|---|
Provider Name | Patricia Ann Shorrock |
First Address | Whippany, NJ 07981-1428 |
Second Address | West Orange, NJ 07052-1000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 07/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S49097 | (02) | NJ |