Provider Demographics
NPI:1710450713
Name:VANOVER, MARIVIC (APRN-BC)
Entity Type:Individual
Prefix:
First Name:MARIVIC
Middle Name:
Last Name:VANOVER
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 FRIES MILL RD STE 301
Mailing Address - Street 2:
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-2016
Mailing Address - Country:US
Mailing Address - Phone:856-374-1881
Mailing Address - Fax:
Practice Address - Street 1:3 BRENDENWOOD DR
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1603
Practice Address - Country:US
Practice Address - Phone:856-874-0202
Practice Address - Fax:856-874-0220
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00886000363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health