Healthcare Provider Details

I. General information

NPI: 1265079990
Provider Name (Legal Business Name): SVETLANA L. KRASNOVA APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 04/04/2021
Certification Date: 04/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PLUM ST FL 5
NEW BRUNSWICK NJ
08901-2066
US

IV. Provider business mailing address

10 PLUM ST FL 5
NEW BRUNSWICK NJ
08901-2066
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-5530
  • Fax: 732-565-9742
Mailing address:
  • Phone: 732-235-5530
  • Fax: 732-565-9742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00972300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: