1902581176 NPI number — MAGELENDE S PAVIERA MSN, RN, AGNP-NC

Table of content: MAGELENDE S PAVIERA MSN, RN, AGNP-NC (NPI 1902581176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902581176 NPI number — MAGELENDE S PAVIERA MSN, RN, AGNP-NC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAVIERA
Provider First Name:
MAGELENDE
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, RN, AGNP-NC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902581176
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34 AVIARY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST DEPTFORD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08086-3838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-451-5521
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2848 S DELSEA DR STE 2C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VINELAND
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08360-7042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-794-9090
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  26NJ01289300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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