Healthcare Provider Details

I. General information

NPI: 1609590918
Provider Name (Legal Business Name): MARIA DAWN CUPO AG-ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 BUTTONWOOD PL
HAZLET NJ
07730-2109
US

IV. Provider business mailing address

34 BUTTONWOOD PL
HAZLET NJ
07730-2109
US

V. Phone/Fax

Practice location:
  • Phone: 347-596-7114
  • Fax:
Mailing address:
  • Phone: 347-596-7114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number676148
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number432504
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: