Provider Demographics
NPI:1306182761
Name:SO, JOANNE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:SO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-2901
Mailing Address - Country:US
Mailing Address - Phone:201-934-7760
Mailing Address - Fax:
Practice Address - Street 1:110 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-1304
Practice Address - Country:US
Practice Address - Phone:973-733-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00404400363LF0000X
NYF337675-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily