Healthcare Provider Details

I. General information

NPI: 1922271048
Provider Name (Legal Business Name): NIYA K PITTS L.P.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 BEACH AVE
PENNS GROVE NJ
08069-1903
US

IV. Provider business mailing address

3 BEACH AVE
PENNS GROVE NJ
08069-1903
US

V. Phone/Fax

Practice location:
  • Phone: 856-299-5782
  • Fax: 856-299-5782
Mailing address:
  • Phone: 856-299-5782
  • Fax: 856-299-5782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number26NP05265500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: