Healthcare Provider Details

I. General information

NPI: 1184081077
Provider Name (Legal Business Name): MARY GERMAIN EDD,ANP-BC,FNAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2016
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 WASHINGTON ST
ROCKY HILL NJ
08553-1029
US

IV. Provider business mailing address

450 CLARKSON AVE BOX 22
BROOKLYN NY
11203-2012
US

V. Phone/Fax

Practice location:
  • Phone: 609-430-1945
  • Fax:
Mailing address:
  • Phone: 718-270-7607
  • Fax: 718-270-7628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NN03172300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: