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General NPI Number Information
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NPI Number | 1902508385
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Entity Type | Organization
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Legal Business Name | ABLE HEALTHCARE NURSE PRACTITIONER IN PSYCHIATRY PLLC
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 09/21/2024
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Provider Practice Location Address
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Address Line | 1221 N CHURCH ST STE 103-E
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City | MOORESTOWN
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State | NJ
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Zip | 08057-1245
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Country | US
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Telephone | 609-471-3560
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Fax | 833-520-1488
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Provider Business Mailing Address
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Address Line | 1221 N CHURCH ST STE 103-E
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City | MOORESTOWN
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State | NJ
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Zip | 08057-1245
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Country | US
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Telephone | 929-663-7542
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Fax | 833-520-1488
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Authorized Official
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Title or Position | CEO
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Name | FAUSAT FUNMILOLA ODUBIYI
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Credential | DNP/PMHNP-BC/APN
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Telephone | 609-471-3560
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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 |
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License Number State |
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