Provider Demographics
NPI:1619975661
Name:DELLERT, JANE C (PHD, RN, APN-C)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:C
Last Name:DELLERT
Suffix:
Gender:F
Credentials:PHD, RN, APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 UPPER HIGHLAND LKS DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07422-1617
Mailing Address - Country:US
Mailing Address - Phone:973-764-3568
Mailing Address - Fax:973-764-5253
Practice Address - Street 1:25 HOLLYWOOD AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-1113
Practice Address - Country:US
Practice Address - Phone:973-882-0880
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN04562900363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics