Healthcare Provider Details

I. General information

NPI: 1447627112
Provider Name (Legal Business Name): RITA NWAKAUSO AGHANWA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 RIVER ROAD
NEW MILFORD NJ
07646-3097
US

IV. Provider business mailing address

880 RIVER ROAD
NEW MILFORD NJ
07646
US

V. Phone/Fax

Practice location:
  • Phone: 201-225-2101
  • Fax: 201-225-2101
Mailing address:
  • Phone: 201-225-2101
  • Fax: 201-225-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00580200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: