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General NPI Number Information
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NPI Number | 1043618747
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Entity Type | Individual
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Provider Name | ALIX DETULLIO APN
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Gender | Female
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Dates
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Enumeration Date | 12/11/2014
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Last Update Date | 12/11/2014
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Provider Practice Location Address
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Address Line | 901 W MAIN ST
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City | FREEHOLD
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State | NJ
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Zip | 07728-2537
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Country | US
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Telephone | 732-431-0023
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Fax |
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Provider Business Mailing Address
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Address Line | 4255 ROUTE 9 N SUITE B
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City | FREEHOLD
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State | NJ
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Zip | 07728-8305
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Country | US
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Telephone | 732-431-0023
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SA2100X
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Taxonomy Name | Acute Care Clinical Nurse Specialist
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License Number | 26NJ00532200
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License Number State | NJ
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