Healthcare Provider Details

I. General information

NPI: 1255006235
Provider Name (Legal Business Name): MIKAELA LOUISE CHUA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIKAELA CHUA RN

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 ROUTE 33
NEPTUNE NJ
07753
US

IV. Provider business mailing address

1945 STATE ROUTE 33
NEPTUNE NJ
07753-4859
US

V. Phone/Fax

Practice location:
  • Phone: 732-775-5500
  • Fax:
Mailing address:
  • Phone: 732-776-4618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR19138700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ01198200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: