Healthcare Provider Details

I. General information

NPI: 1811704596
Provider Name (Legal Business Name): DIVINE G ABREU FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 ROUTE 31 NORTH SUITE #203
CLINTON NJ
08809
US

IV. Provider business mailing address

44 YOUMANS AVE
WASHINGTON NJ
07882-1848
US

V. Phone/Fax

Practice location:
  • Phone: 908-735-4645
  • Fax:
Mailing address:
  • Phone: 908-894-3783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15198100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: