Healthcare Provider Details

I. General information

NPI: 1871221028
Provider Name (Legal Business Name): COURTNEY ELYSE D'ANNUNZIO APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23659 COLUMBUS RD STE 4
COLUMBUS NJ
08022-1980
US

IV. Provider business mailing address

401 ROUTE 73 N STE 320
MARLTON NJ
08053-3426
US

V. Phone/Fax

Practice location:
  • Phone: 609-298-3304
  • Fax:
Mailing address:
  • Phone: 609-298-3304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01351900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: