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General NPI Number Information
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NPI Number | 1306453931
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Entity Type | Individual
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Provider Name | SAKINAH M VICE
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Gender | Female
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Dates
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Enumeration Date | 09/28/2020
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Last Update Date | 09/28/2020
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Provider Practice Location Address
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Address Line | 167 N GROVE ST APT 4B
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City | EAST ORANGE
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State | NJ
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Zip | 07017-4469
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Country | US
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Telephone | 973-337-3329
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Fax |
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Provider Business Mailing Address
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Address Line | 167 N GROVE ST APT 4B
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City | EAST ORANGE
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State | NJ
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Zip | 07017-4469
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Country | US
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Telephone | 973-337-3329
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 26NP06618000
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License Number State | NJ
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