Provider Demographics
NPI:1972723906
Name:ACKERMAN, MARGARET M (APN)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:M
Last Name:ACKERMAN
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 1:765 ROUTE 70 E BLDG A
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2341
Mailing Address - Country:US
Mailing Address - Phone:856-797-4740
Mailing Address - Fax:856-466-9055
Practice Address - Street 1:301 VALLEY MALL WAY STE 110
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5462
Practice Address - Country:US
Practice Address - Phone:360-416-7013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO119561363LP0808X
WAAP60822873363LP0808X
IL209.007666363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL183036OtherHEALTH ALLIANCE
IL370966854006Medicaid
IL370966854011Medicaid
IL640701OtherMEDICARE GROUP PIN NUMBER
WAAP60822873OtherAPN LICENSE
ILCF3444OtherMEDICARE RR
WARN60822872OtherWA LICENSE
IL640701OtherMEDICARE GROUP PIN NUMBER
IL141967Medicare Oscar/Certification
IL640701Medicare Oscar/Certification