Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 26NJ00581400 | NJ |
NPI | 1053787036 |
---|---|
Provider Name | Jennifer Enrique |
First Address | Clifton, NJ 07013 |
Second Address | Clifton, NJ 07013-1645 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2015 |
Last Update Date | 13/08/2015 |