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General NPI Number Information
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NPI Number | 1831856129
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Entity Type | Individual
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Provider Name | NATHALIE BEREDO APN
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Gender | Female
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Dates
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Enumeration Date | 11/21/2021
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Last Update Date | 02/24/2023
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Provider Practice Location Address
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Address Line | 765 ROUTE 10 E STE 201
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City | RANDOLPH
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State | NJ
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Zip | 07869-1925
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Country | US
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Telephone | 973-989-0068
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Fax |
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Provider Business Mailing Address
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Address Line | 8 JESSICA LN
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City | DOVER
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State | NJ
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Zip | 07801-4743
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Country | US
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Telephone | 862-579-0457
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26NR16872500
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License Number State | NJ
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