Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 26NJ01212100 | NJ |
NPI | 1073279527 |
---|---|
Provider Name | Bernadette Nepomuceno |
First Address | Clifton, NJ 07011-3709 |
Second Address | Clifton, NJ 07011-3709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2021 |
Last Update Date | 09/11/2021 |