Healthcare Provider Details

I. General information

NPI: 1396757811
Provider Name (Legal Business Name): SUSAN J WILSON RN,APN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 09/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 SOUTH SHORE ROAD, SUITE 106 HOPE COMMUNITY CANCER CENTER
MARMORA NJ
08223-1271
US

IV. Provider business mailing address

210 SOUTH SHORE ROAD, SUITE 106 HOPE COMMUNITY CANCER CENTER
MARMORA NJ
08223-1271
US

V. Phone/Fax

Practice location:
  • Phone: 609-390-7888
  • Fax: 609-390-2614
Mailing address:
  • Phone: 609-390-7888
  • Fax: 609-390-2614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SX0200X
TaxonomyOncology Clinical Nurse Specialist
License Number26NC07654700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code364SX0200X
TaxonomyOncology Clinical Nurse Specialist
License Number26NR076554700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: