Provider Demographics
NPI:1821348764
Name:DESULME, MARJORY (APN)
Entity Type:Individual
Prefix:
First Name:MARJORY
Middle Name:
Last Name:DESULME
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 1:57 E CENTRE ST APT 1106
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-5410
Mailing Address - Country:US
Mailing Address - Phone:973-235-0548
Mailing Address - Fax:
Practice Address - Street 1:57 E CENTRE ST APT 1106
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-5410
Practice Address - Country:US
Practice Address - Phone:973-235-0548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00392200363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health