MEDICARE: EVELYN TERREROS-RUESTA PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ15159200	NJ

General Provider Information

NPI Number	:	1669291837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVELYN TERREROS-RUESTA PMHNP-BC

Provider Business Mailing Address
First Line	:	1139 SUMMIT AVE APT 4
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07307-3307
Country	:	US
Telephone Number	:	201-681-0338
Fax Number	:

Provider Business Practice Location Address
First Line	:	1139 SUMMIT AVE APT 4
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07307-3307
Country	:	US
Telephone Number	:	201-681-0338
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2024
Last Update Date	:	10/07/2024

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Directions to “ EVELYN TERREROS-RUESTA PMHNP-BC” Practice Location

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