Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 26NJ00030700 | NJ |
NPI | 1023049962 |
---|---|
Provider Name | Patricia Mccormack |
First Address | Pleasantville, NJ 08232-6086 |
Second Address | Egg Harbor Twp, NJ 08234-9752 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 24/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0052175 | (05) | NJ |
Q33485 | (02) |