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General NPI Number Information
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NPI Number | 1568110351
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Entity Type | Individual
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Provider Name | IRIS W. MALDONADO DIAZ MSN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/11/2022
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Last Update Date | 03/23/2022
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Provider Practice Location Address
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Address Line | 1 COOPER PLZ
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City | CAMDEN
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State | NJ
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Zip | 08103-1461
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Country | US
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Telephone | 856-986-0868
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Fax |
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Provider Business Mailing Address
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Address Line | 800 COOPER STREET
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City | CAMDEN
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State | NJ
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Zip | 08103
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Country | US
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Telephone | 856-986-0868
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NJ01263800
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License Number State | NJ
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