Provider Demographics
NPI:1154376127
Name:MANSOR, MESHELL GLASGOW (APN-C)
Entity type:Individual
Prefix:MRS
First Name:MESHELL
Middle Name:GLASGOW
Last Name:MANSOR
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 ROBERTS AVE
Mailing Address - Street 2:
Mailing Address - City:BELLMAWR
Mailing Address - State:NJ
Mailing Address - Zip Code:08031-2711
Mailing Address - Country:US
Mailing Address - Phone:856-728-3251
Mailing Address - Fax:856-669-8488
Practice Address - Street 1:4361 ROUTE 42
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-1794
Practice Address - Country:US
Practice Address - Phone:856-885-4579
Practice Address - Fax:856-885-4582
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11018146363LA2200X
NJ26NJ00097200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ151370Medicare PIN