Provider Demographics
NPI:1417272717
Name:RADD, MARY PATRICIA (MSN, APN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PATRICIA
Last Name:RADD
Suffix:
Gender:F
Credentials:MSN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 780
Mailing Address - Street 2:1001 LACEY RD
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-0780
Mailing Address - Country:US
Mailing Address - Phone:609-693-8900
Mailing Address - Fax:609-971-2888
Practice Address - Street 1:1001 LACEY RD,
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-0780
Practice Address - Country:US
Practice Address - Phone:609-693-8900
Practice Address - Fax:609-971-2888
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00274000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily