Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 26NJ00293600 | NJ |
NPI | 1013282458 |
---|---|
Provider Name | Vivien Tietchen |
First Address | Parlin, NJ 08859-1691 |
Second Address | Parlin, NJ 08859-1691 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2012 |
Last Update Date | 19/03/2012 |