Healthcare Provider Details

I. General information

NPI: 1548566458
Provider Name (Legal Business Name): STEPHANIE NWAMADSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2011
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date: 04/11/2025
Reactivation Date: 09/18/2025

III. Provider practice location address

1606 GEORGETOWN DR
MONROE TOWNSHIP NJ
08831-3317
US

IV. Provider business mailing address

1606 GEORGETOWN DR
MONROE TOWNSHIP NJ
08831-3317
US

V. Phone/Fax

Practice location:
  • Phone: 347-393-2577
  • Fax:
Mailing address:
  • Phone: 347-393-2577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15295000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR17625200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: