Individual
MAILA MARIE MANTILA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
23 MAIN ST STE D1, HOLMDEL, NJ 07733-2136
(732) 571-1000
Mailing address
2 MARLIN CT, JACKSON, NJ 08527-4859
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
26NJ15133600
NJ
Other
Enumeration date
09/30/2024
Last updated
10/07/2024
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