Healthcare Provider Details

I. General information

NPI: 1447563093
Provider Name (Legal Business Name): NANCY ENID MEJIAS-CEPEDA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 NUKO TER
RANDOLPH NJ
07869-4106
US

IV. Provider business mailing address

4 NUKO TER
RANDOLPH NJ
07869-4106
US

V. Phone/Fax

Practice location:
  • Phone: 973-895-9952
  • Fax:
Mailing address:
  • Phone: 973-895-9952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number26NR07501500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: