MEDICARE: MARY DENNIS APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	26NJ000947600	NJ

General Provider Information

NPI Number	:	1477101467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY DENNIS APN

Provider Business Mailing Address
First Line	:	2240 STATE ROUTE 33 STE 114
Second Line	:
City	:	NEPTUNE CITY
State	:	NJ
Zip	:	07753-6121
Country	:	US
Telephone Number	:	732-455-3030
Fax Number	:

Provider Business Practice Location Address
First Line	:	2240 STATE ROUTE 33 STE 114
Second Line	:
City	:	NEPTUNE CITY
State	:	NJ
Zip	:	07753-6121
Country	:	US
Telephone Number	:	732-455-3030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2019
Last Update Date	:	09/03/2019

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Directions to “ MARY DENNIS APN” Practice Location

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