Healthcare Provider Details

I. General information

NPI: 1457711095
Provider Name (Legal Business Name): JACQUELINE THERESE NORRELL DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 PERSHING AVE
RIDGEWOOD NJ
07450-2808
US

IV. Provider business mailing address

217 PERSHING AVE
RIDGEWOOD NJ
07450-2808
US

V. Phone/Fax

Practice location:
  • Phone: 201-689-1435
  • Fax:
Mailing address:
  • Phone: 201-689-1435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00621000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: