Healthcare Provider Details

I. General information

NPI: 1558512293
Provider Name (Legal Business Name): SHARON JEAN PUCHALSKI WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MADISON AVE SUITE 308
MORRISTOWN NJ
07960-6097
US

IV. Provider business mailing address

12 BALL TER
BOONTON NJ
07005-1003
US

V. Phone/Fax

Practice location:
  • Phone: 973-285-0400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number26NO10545000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: