Healthcare Provider Details

I. General information

NPI: 1366455180
Provider Name (Legal Business Name): AMY E. WARD CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY E. WILCOX CRNP

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 COOPER PLZ SUITE 411
CAMDEN NJ
08103-1438
US

IV. Provider business mailing address

3 COOPER PLZ SUITE 411
CAMDEN NJ
08103-1438
US

V. Phone/Fax

Practice location:
  • Phone: 856-342-2270
  • Fax: 856-365-1180
Mailing address:
  • Phone: 856-342-2270
  • Fax: 856-365-1180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP008489
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNJ00183000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: