Healthcare Provider Details

I. General information

NPI: 1467231613
Provider Name (Legal Business Name): DANA LYN MONDON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 MORRIS AVE STE 100
SPRINGFIELD NJ
07081-1100
US

IV. Provider business mailing address

385 MORRIS AVE STE 100
SPRINGFIELD NJ
07081-1100
US

V. Phone/Fax

Practice location:
  • Phone: 973-379-2111
  • Fax:
Mailing address:
  • Phone: 973-379-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ14902400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: