Healthcare Provider Details

I. General information

NPI: 1225305022
Provider Name (Legal Business Name): JOHANNA LYNNE EVERETT APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 10/09/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CAPITAL WAY
PENNINGTON NJ
08534-2520
US

IV. Provider business mailing address

1 CAPITAL WAY
PENNINGTON NJ
08525-3425
US

V. Phone/Fax

Practice location:
  • Phone: 609-537-6000
  • Fax:
Mailing address:
  • Phone: 609-537-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00350200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: