Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 26NJ00677700 | NJ |
Y | 363L00000X | Nurse Practitioner | 25NJ00677700 | NJ |
NPI | 1134670748 |
---|---|
Provider Name | Ms. Brittany Mauro |
First Address | Howell, NJ 07731-2971 |
Second Address | Red Bank, NJ 07701-1530 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2016 |
Last Update Date | 15/08/2017 |