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General NPI Number Information
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NPI Number | 1114159506
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Entity Type | Individual
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Provider Name | MRS. VASHTI ETWARU
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Gender | Female
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Dates
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Enumeration Date | 08/18/2009
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 649 MORRIS AVE
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City | SPRINGFIELD
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State | NJ
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Zip | 07081-1526
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Country | US
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Telephone | 973-795-7955
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Fax |
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Provider Business Mailing Address
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Address Line | 22 CROWN VIEW CT
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City | SPARTA
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State | NJ
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Zip | 07871-3569
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Country | US
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Telephone | 516-343-5339
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 013232
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License Number State | NY
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