Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 26NN05941900 | NJ |
NPI | 1073695391 |
---|---|
Provider Name | Patricia M Haggerty |
First Address | Stratford, NJ 08084-1354 |
Second Address | Stratford, NJ 08084-1354 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 17/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8721904 | (05) | NJ |
S52474 | (02) | NJ |