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General NPI Number Information
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NPI Number | 1164751103
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Entity Type | Organization
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Legal Business Name | DR WENDY KING, LLC
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Dates
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Enumeration Date | 12/22/2009
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Last Update Date | 12/22/2009
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Provider Practice Location Address
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Address Line | 53 KOSSUTH ST FIRST FLOOR
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City | SOMERSET
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State | NJ
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Zip | 08873-2660
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Country | US
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Telephone | 732-322-5769
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Fax | 732-565-9225
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Provider Business Mailing Address
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Address Line | 53 KOSSUTH ST FIRST FLOOR
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City | SOMERSET
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State | NJ
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Zip | 08873-2660
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Country | US
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Telephone | 732-322-5769
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Fax | 732-565-9225
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. EDWINA SKIBA-KING
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Credential | APRN, PHD
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Telephone | 732-322-5769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 26NC04861500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26NC04861500
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License Number State | NJ
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