Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 26NJ00509300 | NJ |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 26NJ00509300 | NJ |
N | 363LG0600X | Nurse Practitioner - Gerontology | 26NJ00509300 | NJ |
NPI | 1235538950 |
---|---|
Provider Name | Mrs. Mini Willphine |
First Address | Wayne, NJ 07470-2168 |
Second Address | Wayne, NJ 07470-2168 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2014 |
Last Update Date | 04/04/2019 |