Healthcare Provider Details

I. General information

NPI: 1306367321
Provider Name (Legal Business Name): ANNA MARKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 IRVING AVE
BRIDGETON NJ
08302-2123
US

IV. Provider business mailing address

333 IRVING AVE
BRIDGETON NJ
08302-2123
US

V. Phone/Fax

Practice location:
  • Phone: 856-575-4251
  • Fax:
Mailing address:
  • Phone: 856-575-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR18842200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00790800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: