MEDICARE: MRS. MINDI BETH URENA APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	26NJ01158700	NJ
2	363L00000X	Nurse Practitioner	26NR15840400	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26NJ01158700	OTHER	NJ	NJ BOARD OF NURSING APN LICENSE

General Provider Information

NPI Number	:	1699448688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MINDI BETH URENA APRN

Provider Business Mailing Address
First Line	:	52 SCENIC CT
Second Line	:
City	:	HACKETTSTOWN
State	:	NJ
Zip	:	07840-1745
Country	:	US
Telephone Number	:	201-446-8186
Fax Number	:

Provider Business Practice Location Address
First Line	:	89 SPARTA AVE STE 200
Second Line	:
City	:	SPARTA
State	:	NJ
Zip	:	07871-1790
Country	:	US
Telephone Number	:	973-726-7220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2021
Last Update Date	:	03/07/2022

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