Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | NN07065200 | NJ |
NPI | 1205098167 |
---|---|
Provider Name | Mrs. Marilyn St Rose |
First Address | New Brunswick, NJ 08901-1766 |
Second Address | New Brunswick, NJ 08902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2008 |
Last Update Date | 01/07/2008 |