Healthcare Provider Details

I. General information

NPI: 1649528811
Provider Name (Legal Business Name): ANNA LUCENA SENO YRAD APN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2012
Last Update Date: 08/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 CORLIES AVE
NEPTUNE NJ
07753-4904
US

IV. Provider business mailing address

710 CEDAR POINT CT
TOMS RIVER NJ
08753-4498
US

V. Phone/Fax

Practice location:
  • Phone: 732-775-8400
  • Fax: 732-775-8401
Mailing address:
  • Phone: 732-608-7368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00369100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: