Individual
PREETHI IDICULLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
968 WENDY CT, UNION, NJ 07083-5637
(917) 858-0953
Mailing address
968 WENDY CT, UNION, NJ 07083-5637
(917) 858-0953
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
26NR1204800
NJ
363LF0000X
Family Nurse Practitioner
Primary
26NJ01318900
NJ
Other
Enumeration date
04/24/2017
Last updated
09/03/2024
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