Healthcare Provider Details

I. General information

NPI: 1902441249
Provider Name (Legal Business Name): AISHA NAJUMA BODDIE-WILLIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2019
Last Update Date: 11/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CLEMENTS BRIDGE RD
BARRINGTON NJ
08007-1814
US

IV. Provider business mailing address

600 CLEMENTS BRIDGE RD
BARRINGTON NJ
08007-1814
US

V. Phone/Fax

Practice location:
  • Phone: 856-547-8000
  • Fax: 856-547-1008
Mailing address:
  • Phone: 856-547-8000
  • Fax: 856-547-1008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN643818
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: