FANTA MIAN

HACKENSACK, NJ
NPI1477216224
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: NJ  26NJ01202000)
Enumeration Date2021-10-19
Last Update Date2022-06-02
Business Address
FANTA MIAN
25 E SALEM ST
HACKENSACK, NJ 07601-7427
Phone number: 973-534-2734
Mailing Address
FANTA MIAN
2552 STANDISH AVE
UNION, NJ 07083-4939
Phone number: 973-534-2734
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