Individual
MICHELLE ITIDIARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
347 MOUNT PLEASANT AVE, SUITE 103, WEST ORANGE, NJ 07052-2744
(908) 420-1361
Mailing address
347 MOUNT PLEASANT AVE, SUITE 103, WEST ORANGE, NJ 07052-2744
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
26NJ00625200
NJ
Other
Enumeration date
12/15/2015
Last updated
11/30/2016
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