MEDICARE: ADVANCED ASSIST, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	26NJ00135000	NJ

General Provider Information

NPI Number	:	1396921383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED ASSIST, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1522
Second Line	:
City	:	MILLVILLE
State	:	NJ
Zip	:	08332-8522
Country	:	US
Telephone Number	:	856-776-3295
Fax Number	:

Provider Business Practice Location Address
First Line	:	994 W SHERMAN AVE
Second Line	:
City	:	VINELAND
State	:	NJ
Zip	:	08360-6937
Country	:	US
Telephone Number	:	856-696-0900
Fax Number	:	973-648-3481

Authorized Official
Title or Position	:	APN
Name	:	MRS. MARIANNE BERNARDINI
Credential	:	APN
Telephone Number	:	856-776-3295

Provider Enumeration Date	:	01/21/2008
Last Update Date	:	04/17/2009

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