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NPI Code Detail

MEDICARE: MARY JO P VETTER RN , APRN, CS

MEDICARE: MARY JO P VETTER RN , APRN, CS
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
1163WG0600XGerontology Registered NurseNJ
2363LA2200XAdult Health Nurse PractitionerNJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538115084
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY JO P VETTER RN , APRN, CS
Provider Business Mailing Address
First Line : PO BOX 729
Second Line :
City : TENAFLY
State : NJ
Zip : 07670-0729
Country : US
Telephone Number : 201-332-3354
Fax Number : 201-536-9047
Provider Business Practice Location Address
First Line : 196 JEWETT AVE
Second Line :
City : JERSEY CITY
State : NJ
Zip : 07304-1804
Country : US
Telephone Number : 201-332-3354
Fax Number : 201-536-9047
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2006
Last Update Date : 09/11/2025

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