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General NPI Number Information
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NPI Number | 1306182761
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Entity Type | Individual
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Provider Name | JOANNE SO FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/12/2012
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Last Update Date | 12/12/2012
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Provider Practice Location Address
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Address Line | 110 WILLIAM ST
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City | NEWARK
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State | NJ
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Zip | 07102-1304
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Country | US
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Telephone | 973-733-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 10 ADAMS RD
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City | SADDLE RIVER
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State | NJ
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Zip | 07458-2901
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Country | US
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Telephone | 201-934-7760
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ00404400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F337675-1
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License Number State | NY
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