=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588811277
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOLIE HAMILTON SHIMP MASTER D.P.M.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2008
-----------------------------------------------------
Last Update Date | 08/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 303 N MAIN ST
-----------------------------------------------------
City | WOODSTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08098-1308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-769-9400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 303 N MAIN ST
-----------------------------------------------------
City | WOODSTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08098-1308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-769-9400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 25MD00297400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------