Provider Demographics
NPI:1538115084
Name:VETTER, MARY JO P (RN , APRN, CS)
Entity Type:Individual
Prefix:
First Name:MARY JO
Middle Name:P
Last Name:VETTER
Suffix:
Gender:F
Credentials:RN , APRN, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-0729
Mailing Address - Country:US
Mailing Address - Phone:201-332-3354
Mailing Address - Fax:201-536-9047
Practice Address - Street 1:196 JEWETT AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1804
Practice Address - Country:US
Practice Address - Phone:201-332-3354
Practice Address - Fax:201-536-9047
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ163WG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WG0600XNursing Service ProvidersRegistered NurseGerontology
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7414404Medicaid
NJS61350Medicare UPIN
NJ7414404Medicaid