Basic Information
| Provider Information | |||||||||
| NPI: | 1821202201 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FEE | ||||||||
| FirstName: | DOLORES | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 SALEM RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | WILLINGBORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080462852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098712060 | ||||||||
| FaxNumber: | 6098713535 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 SALEM RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | WILLINGBORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080462852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098712060 | ||||||||
| FaxNumber: | 6098713535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 12/18/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WR1000X | UP005428G | PA | N | Nursing Service Providers | Registered Nurse | Reproductive Endocrinology/Infertility | 363LW0102X | 26NJ00140200 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | UP005428G | 01 | PA | NURSE PRACTITIONER LICENS | OTHER | 26NJ00140200 | 01 | NJ | NJ LICENSE | OTHER |