Healthcare Provider Details

I. General information

NPI: 1487289906
Provider Name (Legal Business Name): MARY WUMMI EGBEH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY WUMMI JOSHUA

II. Dates (important events)

Enumeration Date: 03/04/2020
Last Update Date: 09/29/2026
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2056 INDIAN DR
VINELAND NJ
08361-6411
US

IV. Provider business mailing address

2056 INDIAN DR
VINELAND NJ
08361-6411
US

V. Phone/Fax

Practice location:
  • Phone: 856-899-8944
  • Fax:
Mailing address:
  • Phone: 856-899-8944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15179300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number26NR216587
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: