Healthcare Provider Details

I. General information

NPI: 1053383794
Provider Name (Legal Business Name): NORA M ROAN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 ROUTE 66 PARKWAY 100
NEPTUNE NJ
07753-2622
US

IV. Provider business mailing address

3535 ROUTE 66 PARKWAY 100
NEPTUNE NJ
07753-2625
US

V. Phone/Fax

Practice location:
  • Phone: 732-643-4350
  • Fax: 732-643-4398
Mailing address:
  • Phone: 732-643-4350
  • Fax: 732-643-4398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: