Provider Demographics
NPI:1184964868
Name:SOUTH JERSEY NURSE PRACTITIONERS SERVICES
Entity type:Organization
Organization Name:SOUTH JERSEY NURSE PRACTITIONERS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAJAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ONUOHA
Authorized Official - Suffix:
Authorized Official - Credentials:APN-BC
Authorized Official - Phone:856-228-1989
Mailing Address - Street 1:100 N BLACK HORSE PIKE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-3042
Mailing Address - Country:US
Mailing Address - Phone:856-228-1989
Mailing Address - Fax:856-228-1934
Practice Address - Street 1:100 N BLACK HORSE PIKE
Practice Address - Street 2:SUITE C
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-3042
Practice Address - Country:US
Practice Address - Phone:856-228-1989
Practice Address - Fax:856-228-1934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-18
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00379200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty