Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 26NJ00104200 | NJ |
NPI | 1003030669 |
---|---|
Provider Name | Mrs. Phygenia Y Nimoh |
First Address | Flanders, NJ 07836-9334 |
Second Address | Chester, NJ 07930-2547 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 26/09/2013 |