Healthcare Provider Details

I. General information

NPI: 1699448688
Provider Name (Legal Business Name): MINDI BETH URENA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 SPARTA AVE STE 200
SPARTA NJ
07871-1790
US

IV. Provider business mailing address

52 SCENIC CT
HACKETTSTOWN NJ
07840-1745
US

V. Phone/Fax

Practice location:
  • Phone: 973-726-7220
  • Fax:
Mailing address:
  • Phone: 201-446-8186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ01158700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NR15840400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: