Provider Demographics
NPI:1144406620
Name:WILSON-TARPEH, ELLEN (DNP/FNP/APN-BC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:WILSON-TARPEH
Suffix:
Gender:F
Credentials:DNP/FNP/APN-BC
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:WILSON-DORSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP/FNP/APN-BCAPN
Mailing Address - Street 1:817 FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1539
Mailing Address - Country:US
Mailing Address - Phone:856-583-2400
Mailing Address - Fax:
Practice Address - Street 1:817 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1539
Practice Address - Country:US
Practice Address - Phone:215-227-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00284600363LF0000X
PASP009623363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA120576XRUMedicare PIN