Provider Demographics
NPI:1366691925
Name:VANHORN, MARY (RN MS APN-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:VANHORN
Suffix:
Gender:F
Credentials:RN MS APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 RIDGEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1348
Mailing Address - Country:US
Mailing Address - Phone:973-966-6333
Mailing Address - Fax:
Practice Address - Street 1:220 RIDGEDALE AVE
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1348
Practice Address - Country:US
Practice Address - Phone:973-966-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN05462400363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics