Provider Demographics
NPI:1255593703
Name:KATES, JEANNETTE MARIE (APN)
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:MARIE
Last Name:KATES
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 1:5 EVES DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3135
Mailing Address - Country:US
Mailing Address - Phone:856-596-1600
Mailing Address - Fax:856-552-2217
Practice Address - Street 1:5 EVES DR
Practice Address - Street 2:SUITE 300
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3135
Practice Address - Country:US
Practice Address - Phone:856-596-1600
Practice Address - Fax:856-552-2217
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP004616H363LG0600X
NJ26NJ00170700363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology