Provider Demographics
NPI:1760564504
Name:MACK, JANET P (RN, MSN, APN-C)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:P
Last Name:MACK
Suffix:
Gender:F
Credentials:RN, MSN, APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HATHAWAY PL
Mailing Address - Street 2:
Mailing Address - City:GLEN RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07028-1507
Mailing Address - Country:US
Mailing Address - Phone:973-743-8195
Mailing Address - Fax:
Practice Address - Street 1:6 HATHAWAY PL
Practice Address - Street 2:
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028-1507
Practice Address - Country:US
Practice Address - Phone:973-743-8195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN08609600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS61786Medicare UPIN
NJ004789XVAMedicare UPIN