Provider Demographics
NPI:1437414117
Name:QUACKENBUSH, PATRYCJA BOZENA (APN-C)
Entity Type:Individual
Prefix:MRS
First Name:PATRYCJA
Middle Name:BOZENA
Last Name:QUACKENBUSH
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:PATRYCJA
Other - Middle Name:BOZENA
Other - Last Name:KASPRZAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:908-273-4300
Mailing Address - Fax:
Practice Address - Street 1:34 MOUNTAIN BLVD STE C
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-2640
Practice Address - Country:US
Practice Address - Phone:908-315-5070
Practice Address - Fax:908-484-9646
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00382700363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care