Provider Demographics
NPI:1740648732
Name:JENNINGS, MARY L (APN, C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:JENNINGS
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 1:103 PEACH TREE LN
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5252
Mailing Address - Country:US
Mailing Address - Phone:609-561-1700
Mailing Address - Fax:609-380-4436
Practice Address - Street 1:103 PEACH TREE LN
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5252
Practice Address - Country:US
Practice Address - Phone:609-561-1700
Practice Address - Fax:609-380-4436
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00605000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health