| NPI | 1043780117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CALLISTA N IWUALA Owner 201-362-9916 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family |
| Enumeration Date | 2018-11-30 |
| Last Update Date | 2025-04-16 |