Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 25MA08262500 | NJ |
NPI | 1134305667 |
---|---|
Provider Name | Latisse Monique Mays-Stovall |
First Address | West Orange, NJ 07052-3315 |
Second Address | Newark, NJ 07112-2027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2008 |
Last Update Date | 15/01/2008 |