Provider Demographics
NPI:1477101467
Name:DENNIS, MARY (APN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:DENNIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CATHERINE
Other - Last Name:WEBBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2240 STATE ROUTE 33 STE 114
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6121
Mailing Address - Country:US
Mailing Address - Phone:732-455-3030
Mailing Address - Fax:
Practice Address - Street 1:2240 STATE ROUTE 33 STE 114
Practice Address - Street 2:
Practice Address - City:NEPTUNE CITY
Practice Address - State:NJ
Practice Address - Zip Code:07753-6121
Practice Address - Country:US
Practice Address - Phone:732-455-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ000947600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner