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General NPI Number Information
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NPI Number | 1396034120
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Entity Type | Individual
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Provider Name | ODETTA RUTH SUAREZ FNP
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Gender | Female
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Dates
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Enumeration Date | 04/01/2011
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 44 JONES ST
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City | NEWARK
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State | NJ
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Zip | 07103
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Country | US
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Telephone | 973-878-9020
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Fax |
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Provider Business Mailing Address
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Address Line | 969 E LAWN DR
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City | TEANECK
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State | NJ
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Zip | 07666-6604
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Country | US
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Telephone |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NJ00324100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 341048
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ00324100
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NJ00324100
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License Number State | NJ
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26NJ00324100
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License Number State | NJ
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