Healthcare Provider Details

I. General information

NPI: 1508034364
Provider Name (Legal Business Name): SUSAN EVE BOISNIER NURSE PRAC APN C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 MADISON AVE M-WEO-01 STUDENT HEALTH
MADISON NJ
07940-1099
US

IV. Provider business mailing address

285 MADISON AVE M-WEO-01
MADISON NJ
07940-1099
US

V. Phone/Fax

Practice location:
  • Phone: 973-443-8535
  • Fax: 973-443-8174
Mailing address:
  • Phone: 973-443-8535
  • Fax: 973-443-8174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number058733
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00117400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: