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General NPI Number Information
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NPI Number | 1205905809
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Entity Type | Individual
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Provider Name | LORETTA M NINIVAGGI RN, APN,C CDE
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Gender | Female
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 07/19/2010
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Provider Practice Location Address
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Address Line | 2240 STATE ROUTE 33
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City | NEPTUNE
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State | NJ
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Zip | 07753-6110
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Country | US
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Telephone | 732-897-3980
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Fax | 732-897-3982
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Provider Business Mailing Address
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Address Line | 2240 STATE ROUTE 33
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City | NEPTUNE
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State | NJ
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Zip | 07753-6110
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Country | US
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Telephone | 732-897-3980
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Fax | 732-897-3982
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NJ00067000
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License Number State | NJ
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