Provider Demographics
NPI:1396327789
Name:DOURNEY, VIVIAN MARIA (APN)
Entity type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:MARIA
Last Name:DOURNEY
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 1:122 N MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-1019
Mailing Address - Country:US
Mailing Address - Phone:908-229-3962
Mailing Address - Fax:
Practice Address - Street 1:122 N MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-1019
Practice Address - Country:US
Practice Address - Phone:908-229-3962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-25
Last Update Date:2021-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0OtherNA