Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 26NJ01143500 | NJ |
NPI | 1992388938 |
---|---|
Provider Name | Jennifer Lisa Dougan |
First Address | Voorhees, NJ 08043-1140 |
Second Address | Voorhees, NJ 08043-1140 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2021 |
Last Update Date | 28/04/2021 |