Individual
MISS STACEY MELISSA BLACKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
9 WAYNE AVE, EAST ORANGE, NJ 07018
(201) 341-8190
Mailing address
9 WAYNE AVE, EAST ORANGE, NJ 07018-1907
(201) 341-8190
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
26NJ00286100
NJ
363LF0000X
Family Nurse Practitioner
26NJ00286100
NJ
363LP2300X
Primary Care Nurse Practitioner
Primary
26NJ00286100
NJ
Other
Enumeration date
05/14/2010
Last updated
07/25/2018
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