Healthcare Provider Details

I. General information

NPI: 1386257509
Provider Name (Legal Business Name): MRS. BRITTANY LAUREN CHITTUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2020
Last Update Date: 08/27/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 COVERED BRIDGE RD
CHERRY HILL NJ
08034-2945
US

IV. Provider business mailing address

233 MAINE AVE
CHERRY HILL NJ
08002-3015
US

V. Phone/Fax

Practice location:
  • Phone: 856-429-2224
  • Fax:
Mailing address:
  • Phone: 215-888-2326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number26NJ00986000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ00986000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: