Provider Demographics
NPI: | 1083462741 |
---|---|
Name: | GD HEALTH & WELLNESS MOBILE EXAM, LLC |
Entity type: | Organization |
Organization Name: | GD HEALTH & WELLNESS MOBILE EXAM, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | FAMILY NURSE PRACTITIONER |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | GENEAN |
Authorized Official - Middle Name: | MARIE |
Authorized Official - Last Name: | DOYLE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MSN, FNP |
Authorized Official - Phone: | 856-982-9502 |
Mailing Address - Street 1: | 614 E LANDIS AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | VINELAND |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08360-8027 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 856-982-9502 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 614 E LANDIS AVE |
Practice Address - Street 2: | |
Practice Address - City: | VINELAND |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08360-8027 |
Practice Address - Country: | US |
Practice Address - Phone: | 856-982-9502 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2024-05-08 |
Last Update Date: | 2024-05-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Single Specialty |