Healthcare Provider Details

I. General information

NPI: 1043156540
Provider Name (Legal Business Name): JESSICA HAUSSMAN BSN, RN-BC,MSN, AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3718 CHURCH RD
MOUNT LAUREL NJ
08054-1104
US

IV. Provider business mailing address

3 KENNERLY CT
MARLTON NJ
08053-2703
US

V. Phone/Fax

Practice location:
  • Phone: 856-235-7100
  • Fax:
Mailing address:
  • Phone: 609-234-8767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ15562500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: