Healthcare Provider Details

I. General information

NPI: 1205040458
Provider Name (Legal Business Name): ROBERTA C SCUDDER MSN,RN,NP,C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 E BROAD ST
WESTFIELD NJ
07090-2116
US

IV. Provider business mailing address

532 E BROAD ST
WESTFIELD NJ
07090-2116
US

V. Phone/Fax

Practice location:
  • Phone: 908-232-8077
  • Fax: 908-232-8447
Mailing address:
  • Phone: 908-232-8077
  • Fax: 908-232-8447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberNN55500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: