Provider Demographics
NPI:1174533608
Name:FOX, WANDA (APN,C)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:APN,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 BRETTON WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3134
Mailing Address - Country:US
Mailing Address - Phone:609-871-2060
Mailing Address - Fax:609-871-3535
Practice Address - Street 1:1000 SALEM RD
Practice Address - Street 2:SUITE B
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-2852
Practice Address - Country:US
Practice Address - Phone:609-871-2060
Practice Address - Fax:609-871-3535
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNN75220363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7563507Medicaid
NJ009145BBVMedicare ID - Type Unspecified
NJ7563507Medicaid