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General NPI Number Information
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NPI Number | 1023358561
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Entity Type | Organization
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Legal Business Name | HOSPITAL TO HOME TRANSITIONAL DIABETES CARE LIMITED LIABILITY COMPANY
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Dates
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Enumeration Date | 02/20/2013
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Last Update Date | 02/20/2013
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Provider Practice Location Address
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Address Line | 67 STRATTON LN
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City | SEWELL
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State | NJ
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Zip | 08080-2253
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Country | US
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Telephone | 856-889-9577
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Fax |
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Provider Business Mailing Address
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Address Line | 67 STRATTON LN
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City | SEWELL
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State | NJ
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Zip | 08080-2253
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Country | US
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Telephone | 856-889-9577
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER/DIRECTOR
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Name | KELLY LYNN DONNELL-JACKSON
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Credential | APN-C
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Telephone | 856-889-9577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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