Basic Information
| Provider Information | |||||||||
| NPI: | 1689002602 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOINER | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 TRENTON ROAD | ||||||||
| Address2: | |||||||||
| City: | BROWN MILLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098936611 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 TRENTON ROAD | ||||||||
| Address2: | |||||||||
| City: | BROWN MILLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098936611 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2013 | ||||||||
| LastUpdateDate: | 02/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 26NJ00462500 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 163W00000X | 26NO11452800 | NJ | N | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 0708763 | 05 | NJ | MEDICAID |