Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 26NO/NN08592300 | NJ |
NPI | 1003918145 |
---|---|
Provider Name | Susan Paglione |
First Address | Camden, NJ 08103 |
Second Address | Camden, NJ 08103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 12/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8560307 | (05) | NJ |