Provider Demographics
NPI:1164453809
Name:SMOLLOCK, WENDY ANN (NP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ANN
Last Name:SMOLLOCK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CLEMENTS BRIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08007-1814
Mailing Address - Country:US
Mailing Address - Phone:856-547-8000
Mailing Address - Fax:856-547-8020
Practice Address - Street 1:600 CLEMENTS BRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08007-1814
Practice Address - Country:US
Practice Address - Phone:856-547-8000
Practice Address - Fax:856-547-8020
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN10540600363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8744905Medicaid
500030339OtherRAILROAD MEDICARE
054774Medicare ID - Type Unspecified
P50198Medicare UPIN