Provider Demographics
NPI:1497999601
Name:BEITZ, JANICE M (APRN)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:M
Last Name:BEITZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 GROVE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1736
Mailing Address - Country:US
Mailing Address - Phone:856-546-3900
Mailing Address - Fax:856-546-3908
Practice Address - Street 1:120 WHITE HORSE PIKE
Practice Address - Street 2:SUITE 103
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1927
Practice Address - Country:US
Practice Address - Phone:856-546-3900
Practice Address - Fax:856-546-3908
Is Sole Proprietor?:No
Enumeration Date:2009-05-01
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00156600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00273000OtherCDS