Healthcare Provider Details

I. General information

NPI: 1467760843
Provider Name (Legal Business Name): HEAVEN SENT MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2010
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 E LAKE AVE
RAHWAY NJ
07065-4942
US

IV. Provider business mailing address

284 E LAKE AVE
RAHWAY NJ
07065-4942
US

V. Phone/Fax

Practice location:
  • Phone: 732-259-5156
  • Fax:
Mailing address:
  • Phone: 732-259-5156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00084000
License Number StateNJ

VIII. Authorized Official

Name: LYNN RENAY PARKER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: ANP
Phone: 732-259-5156