Healthcare Provider Details

I. General information

NPI: 1013459064
Provider Name (Legal Business Name): ANGELA THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA HUNTER

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 WOODSTOWN ROAD
SALEM NJ
08079
US

IV. Provider business mailing address

310 WOODSTOWN ROAD
SALEM NJ
08079
US

V. Phone/Fax

Practice location:
  • Phone: 856-339-6038
  • Fax: 856-935-7195
Mailing address:
  • Phone: 856-339-6038
  • Fax: 856-935-7195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00649600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: