Healthcare Provider Details

I. General information

NPI: 1841725470
Provider Name (Legal Business Name): JODI LAUGHLIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 YOUNG AVE SUITE 180 FRONT
MOORESTOWN NJ
08057
US

IV. Provider business mailing address

400 HIGHWAY
RIVERTON NJ
08077
US

V. Phone/Fax

Practice location:
  • Phone: 856-291-8600
  • Fax: 856-291-8610
Mailing address:
  • Phone: 856-296-4736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP017170
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00721900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: