Doctor Name: | LOURDES VERGARA |
NPI Number: | 1669860946 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 26NJ00535000 |
Business Practice Address: | 420 Daniel Dr Stewartsville, NJ - 088863204 |
Business Phone Number: | 9083371005 |
Business Fax Number: | 9084548914 |
Mailing Address: | 420 Daniel Dr, STEWARTSVILLE |
State: | NJ |
Postal Code: | 088863204 |
Phone Number: | 9083371005 |
Fax Number: | 9084548914 |
NPI Enumeration Date: | 01/08/2015 |
NPI Last Update Date: | 01/08/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | 26NJ00535000 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |