Basic Information
| Provider Information | |||||||||
| NPI: | 1366709917 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BATES | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | ALLAN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSN, APN, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1925 PACIFIC AVE | ||||||||
| Address2: | |||||||||
| City: | ATLANTIC CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 084016713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094418127 | ||||||||
| FaxNumber: | 6094418021 | ||||||||
| Practice Location | |||||||||
| Address1: | 1925 PACIFIC AVE | ||||||||
| Address2: | |||||||||
| City: | ATLANTIC CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 084016713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094418127 | ||||||||
| FaxNumber: | 6094418021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2012 | ||||||||
| LastUpdateDate: | 10/05/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 26NR10494800 | NJ | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 26NJ00392700 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.