Healthcare Provider Details

I. General information

NPI: 1952923443
Provider Name (Legal Business Name): MILAGROS ROELA CENTENO CADACIO APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1944 ROUTE 33 SUITE 201
NEPTUNE NJ
07753-0775
US

IV. Provider business mailing address

221 GRANVILLE CIR
EGG HARBOR TOWNSHIP NJ
08234-6011
US

V. Phone/Fax

Practice location:
  • Phone: 732-776-4618
  • Fax:
Mailing address:
  • Phone: 609-233-4447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26NJ01032900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: