Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 187124 | NJ |
NPI | 1104442375 |
---|---|
Provider Name | Nishaya Mcnair |
First Address | Somerville, NJ 08876-1654 |
Second Address | Somerville, NJ 08876-1654 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2020 |
Last Update Date | 23/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09110105 | 09110105 (01) | NJ |