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General NPI Number Information
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NPI Number | 1902372824
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Entity Type | Individual
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Provider Name | JENESSA DIETERLE MS, FNP-BC, NP-C
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Gender | Female
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Dates
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Enumeration Date | 10/18/2018
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Last Update Date | 10/18/2018
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Provider Practice Location Address
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Address Line | 435 SOUTH ST
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City | MORRISTOWN
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State | NJ
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Zip | 07960-6422
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Country | US
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Telephone | 973-791-7507
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Fax |
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Provider Business Mailing Address
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Address Line | 443 LONG HILL DR
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City | SHORT HILLS
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State | NJ
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Zip | 07078-1207
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Country | US
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Telephone | 703-785-1846
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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 | 26NJ00866900
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License Number State | NJ
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