MEDICARE: MS. JOANNE LOREN JACALAN APN-C

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	363L00000X	Nurse Practitioner	26NJ00057000	NJ

General Provider Information

NPI Number	:	1730279746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOANNE LOREN JACALAN APN-C

Provider Business Mailing Address
First Line	:	177 TEN EYCK ST
Second Line	:
City	:	SOUTH PLAINFIELD
State	:	NJ
Zip	:	07080-4518
Country	:	US
Telephone Number	:	908-737-4889
Fax Number	:	908-737-4894

Provider Business Practice Location Address
First Line	:	1000 MORRIS AVE
Second Line	:	DOWNS HALL ROOM 126
City	:	UNION
State	:	NJ
Zip	:	07083-7133
Country	:	US
Telephone Number	:	908-737-4880
Fax Number	:	908-737-4894

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	05/18/2010

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