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General NPI Number Information
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NPI Number | 1124579198
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Entity Type | Individual
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Provider Name | JENNIFER ANN O'SHAUGHNESSY RN, APN, AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/14/2016
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Last Update Date | 04/10/2024
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Provider Practice Location Address
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Address Line | 201 LYONS AVE
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City | NEWARK
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State | NJ
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Zip | 07112-2027
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Country | US
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Telephone | 973-926-7055
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Fax |
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Provider Business Mailing Address
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Address Line | 13 FOXWOOD DR APT G
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City | MORRIS PLAINS
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State | NJ
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Zip | 07950-2636
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Country | US
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Telephone | 862-812-7770
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 26NJ00674900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26NJ00674900
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License Number State | NJ
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