Provider Demographics
NPI:1124103635
Name:MCKEON, DOROTHY LOIS (APN-C)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:LOIS
Last Name:MCKEON
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 UPPER WAY
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07885
Mailing Address - Country:US
Mailing Address - Phone:973-537-6670
Mailing Address - Fax:
Practice Address - Street 1:1 BAY AVE
Practice Address - Street 2:MOUNTAINSIDE HOSPITAL
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042
Practice Address - Country:US
Practice Address - Phone:973-429-6000
Practice Address - Fax:973-680-7736
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN04036200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health