Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 26NJ00642800 | NJ |
NPI | 1013369826 |
---|---|
Provider Name | Dana Delatush |
First Address | Long Branch, NJ 07740-5211 |
Second Address | Long Branch, NJ 07740-6303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2016 |
Last Update Date | 05/07/2016 |