Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 26NJ00521200 | NJ |
NPI | 1083015762 |
---|---|
Provider Name | Stephanie Corpron |
First Address | North Bergen, NJ 07047-4424 |
Second Address | Jersey City, NJ 07302-4508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2014 |
Last Update Date | 16/08/2017 |