=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376858365
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VINELAND HEALTH DEPARTMENT PUBLIC HEALTH NURSING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2010
-----------------------------------------------------
Last Update Date | 08/13/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 610 E MONTROSE ST SUITE 1
-----------------------------------------------------
City | VINELAND
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08360-4660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-794-4000
-----------------------------------------------------
Fax | 856-362-8986
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1508
-----------------------------------------------------
City | VINELAND
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08362-1508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-794-4000
-----------------------------------------------------
Fax | 856-362-8986
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PUBLIC HEALTH NURSE SUPERVISOR
-----------------------------------------------------
Name | ELIZABETH CUBBAGE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 856-794-4000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------