Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 26NJ00997700 | NJ |
NPI | 1346884996 |
---|---|
Provider Name | Ms. Marissa Rodriguez |
First Address | Camden, NJ 08103-1088 |
Second Address | Camden, NJ 08103-1461 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2019 |
Last Update Date | 25/02/2020 |