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General NPI Number Information
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NPI Number | 1831857051
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Entity Type | Individual
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Provider Name | MISS MIHOLLY PRIMUS
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Gender | Female
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Dates
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Enumeration Date | 12/05/2021
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Last Update Date | 12/05/2021
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Provider Practice Location Address
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Address Line | 15 BROOKSIDE DR APT B
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City | CLIFTON
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State | NJ
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Zip | 07012-6327
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Country | US
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Telephone | 201-960-8863
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Fax |
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Provider Business Mailing Address
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Address Line | 15 BROOKSIDE DR APT B
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City | CLIFTON
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State | NJ
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Zip | 07012-6327
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Country | US
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Telephone | 201-960-8863
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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 | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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