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Organization
SIDWA ENTERPRISE II, LLC
Active
Organization
SIDWA ENTERPRISE II, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICKIE S SIDWA ANP (PRESIDENT OWNER)
(609) 339-5667
Entity
Organization
Contact information
Practice address
1043 MONTAUK DR, FORKED RIVER, NJ 08731-2004
(609) 339-5667
(888) 836-3950
Mailing address
1043 MONTAUK DR, FORKED RIVER, NJ 08731-2004
(609) 339-5667
(888) 836-3950
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
26NN10119300
NJ
Other
Enumeration date
05/04/2016
Last updated
05/10/2016
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