Individual
AMANDA EVE IMMERBLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, FNP-BC
Contact information
Practice address
256 BROAD ST, BLOOMFIELD, NJ 07003-2766
(973) 743-4450
Mailing address
33 SMITH LN, SOMERS, NY 10589-1922
(914) 844-6119
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
26NR24627100
NJ
163W00000X
Registered Nurse
713221
NY
363LF0000X
Family Nurse Practitioner
Primary
26NJ15046300
NJ
363LF0000X
Family Nurse Practitioner
353866
NY
Other
Enumeration date
04/03/2024
Last updated
04/03/2024
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