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General NPI Number Information
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NPI Number | 1982056164
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Entity Type | Individual
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Provider Name | SHAWNE SIMONE FNP
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Gender | Female
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Dates
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Enumeration Date | 07/12/2016
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Last Update Date | 07/12/2016
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Provider Practice Location Address
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Address Line | 468 PARISH DR
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City | WAYNE
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State | NJ
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Zip | 07470
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Country | US
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Telephone | 973-305-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 37 LOYOLA PL
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City | OAKLAND
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State | NJ
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Zip | 07436-3506
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Country | US
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Telephone | 201-677-0970
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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 | 26NJ00528100
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License Number State | NJ
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