Healthcare Provider Details

I. General information

NPI: 1710258918
Provider Name (Legal Business Name): ROSEMARY BRENNAN MCGONIGLE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 BERLIN CROSS KEYS RD
WILLIAMSTOWN NJ
08094-3473
US

IV. Provider business mailing address

134 BRIDGETON PIKE STE C
MULLICA HILL NJ
08062-2616
US

V. Phone/Fax

Practice location:
  • Phone: 856-885-2790
  • Fax: 856-221-4108
Mailing address:
  • Phone: 856-507-2783
  • Fax: 856-221-4138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00713900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN288228L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR07189100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: