Provider Demographics
NPI:1710321583
Name:VANDEGRIFT, DELORES ELIZABETH (APN)
Entity Type:Individual
Prefix:MRS
First Name:DELORES
Middle Name:ELIZABETH
Last Name:VANDEGRIFT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:212 W ROUTE 38 STE 400
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3259
Mailing Address - Country:US
Mailing Address - Phone:856-235-0264
Mailing Address - Fax:856-235-4635
Practice Address - Street 1:212 W ROUTE 38 STE 400
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3259
Practice Address - Country:US
Practice Address - Phone:856-235-0264
Practice Address - Fax:856-235-0463
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00766000363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner