Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 26NJ00456700 | NJ |
NPI | 1023499886 |
---|---|
Provider Name | Mrs. Latifa Fedai |
First Address | Livingston, NJ 07039-2114 |
Second Address | Fayettevill, NC 28301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2015 |
Last Update Date | 17/06/2015 |