Healthcare Provider Details

I. General information

NPI: 1235334814
Provider Name (Legal Business Name): MARIAN W MOTE CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MERCHANTVILLE PEDIATRICS- A DIVISION OF CHA 1 S. CENTRE STREET, SUITE 100
MERCHANTVILLE NJ
08109
US

IV. Provider business mailing address

50 BROADACRE DR
MOUNT LAUREL NJ
08054-4705
US

V. Phone/Fax

Practice location:
  • Phone: 856-665-7337
  • Fax: 856-665-3938
Mailing address:
  • Phone: 856-234-1031
  • Fax: 856-665-6907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NN05232700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: