Individual
LILET WAYNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
297 KERRIGAN BLVD, NEWARK, NJ 07106-3451
(973) 230-3470
Mailing address
297 KERRIGAN BLVD, NEWARK, NJ 07106-3451
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
588567-1
NY
Other
Enumeration date
06/22/2010
Last updated
06/22/2010
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