=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104433747
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RENAY DURLING-GROVER DNP, APN-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2020
-----------------------------------------------------
Last Update Date | 09/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 MADISON AVE # 88
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07960-6136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-971-5000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 FAR VIEW RD
-----------------------------------------------------
City | GREAT MEADOWS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07838-2700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-321-6240
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 26NJ01056900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------