Basic Information
| Provider Information | |||||||||
| NPI: | 1083656888 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCDUFFIE | ||||||||
| FirstName: | SHIRLEY | ||||||||
| MiddleName: | |||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 741 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071044309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734831300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 741 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071044309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734831300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 06/05/2008 | ||||||||
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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 | 163W00000X | 26NO06323700 | NJ | N | Nursing Service Providers | Registered Nurse | 367A00000X | 25ME00023001 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 1932370483 | 01 | NJ | 101 LUDLOW | OTHER | 1740345693 | 01 | NJ | 741 BROADWAY | OTHER | 6392105 | 05 | NJ | MEDICAID | 1194996645 | 01 | NJ | 444 WILLIAM ST | OTHER | 1548431091 | 01 | NJ | 982 BROAD ST | OTHER | 1619148160 | 01 | NJ | 516 BERGEN ST | OTHER | 1235300799 | 01 | NJ | 37 N DAY | OTHER | 1972778413 | 01 | NJ | 1150 SPRINGFIELD | OTHER | 1063683258 | 01 | NJ | 751 BROADWAY | OTHER |