1215140637 NPI number — MRS. PAMELA D KANCE BROLIN APRN

Table of content: MRS. PAMELA D KANCE BROLIN APRN (NPI 1215140637)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215140637 NPI number — MRS. PAMELA D KANCE BROLIN APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KANCE BROLIN
Provider First Name:
PAMELA
Provider Middle Name:
D
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215140637
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4250 US HIGHWAY 1
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
MONMOUTH JUNCTION
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08852-1966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-438-3666
Provider Business Mailing Address Fax Number:
732-438-1660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4250 US HIGHWAY 1
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
MONMOUTH JUNCTION
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08852-1966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-438-3666
Provider Business Practice Location Address Fax Number:
732-438-1660
Provider Enumeration Date:
05/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WP0808X , with the licence number:  26NR04738000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com