Healthcare Provider Details

I. General information

NPI: 1538115084
Provider Name (Legal Business Name): MARY JO P VETTER RN , APRN, CS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 JEWETT AVE
JERSEY CITY NJ
07304-1804
US

IV. Provider business mailing address

PO BOX 729
TENAFLY NJ
07670-0729
US

V. Phone/Fax

Practice location:
  • Phone: 201-332-3354
  • Fax: 201-536-9047
Mailing address:
  • Phone: 201-332-3354
  • Fax: 201-536-9047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: