Provider Demographics
NPI:1215104963
Name:BUONANNO HAMRAH, MARISA (NP)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:BUONANNO HAMRAH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 OLD SHORT HILLS ROAD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052
Mailing Address - Country:US
Mailing Address - Phone:973-243-9300
Mailing Address - Fax:973-325-8573
Practice Address - Street 1:101 OLD SHORT HILLS ROAD
Practice Address - Street 2:SUITE 400
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052
Practice Address - Country:US
Practice Address - Phone:973-243-9300
Practice Address - Fax:973-325-8573
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00212400363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health