Healthcare Provider Details

I. General information

NPI: 1386716678
Provider Name (Legal Business Name): MILDRED E MCCASKILL RNC NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 BROADWAY
CAMDEN NJ
08013
US

IV. Provider business mailing address

21 RIDGEVIEW PLACE
WILLINGBORO NJ
08046
US

V. Phone/Fax

Practice location:
  • Phone: 856-365-3519
  • Fax:
Mailing address:
  • Phone: 609-835-2685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NN05678200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: