Provider Demographics
NPI:1659974186
Name:VAN DER NET, MARY CATHLEEN (APN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CATHLEEN
Last Name:VAN DER NET
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 CAMPUS PKWY STE 303
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6817
Mailing Address - Country:US
Mailing Address - Phone:732-202-8071
Mailing Address - Fax:
Practice Address - Street 1:1350 CAMPUS PKWY STE 303
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07753-6817
Practice Address - Country:US
Practice Address - Phone:732-202-8071
Practice Address - Fax:732-922-6026
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01078900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner