Healthcare Provider Details

I. General information

NPI: 1144953241
Provider Name (Legal Business Name): EILEEN M FENNELL DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MADISON AVE
MORRISTOWN NJ
07960-6136
US

IV. Provider business mailing address

320 SEAPORT LN # 2117
MOUNT PLEASANT SC
29464-2996
US

V. Phone/Fax

Practice location:
  • Phone: 973-971-5000
  • Fax:
Mailing address:
  • Phone: 973-271-8148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number26NR18456800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ01377700
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6NJ01377700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: