Provider Demographics
NPI:1063163111
Name:BADEMOSI, DIONNE DESIREE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:DIONNE
Middle Name:DESIREE
Last Name:BADEMOSI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:DIONNE
Other - Middle Name:DESIREE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6122 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-2377
Mailing Address - Country:US
Mailing Address - Phone:856-952-2966
Mailing Address - Fax:
Practice Address - Street 1:308 NJ- 38 E
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057
Practice Address - Country:US
Practice Address - Phone:856-722-9333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01250100363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care