Provider Demographics
NPI:1083656888
Name:MCDUFFIE, SHIRLEY (CNM)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:MCDUFFIE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-4309
Mailing Address - Country:US
Mailing Address - Phone:973-483-1300
Mailing Address - Fax:
Practice Address - Street 1:741 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-4309
Practice Address - Country:US
Practice Address - Phone:973-483-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO06323700163W00000X
NJ25ME00023001367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1932370483Other101 LUDLOW
NJ1740345693Other741 BROADWAY
NJ6392105Medicaid
NJ1194996645Other444 WILLIAM ST
NJ1548431091Other982 BROAD ST
NJ1619148160Other516 BERGEN ST
NJ1235300799Other37 N DAY
NJ1972778413Other1150 SPRINGFIELD
NJ1063683258Other751 BROADWAY
NJ1235300799Other37 N DAY