Individual
THERESE EXANTUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
324 S CENTER ST, APT C-1, ORANGE, NJ 07050-3326
(973) 609-0117
Mailing address
324 S CENTER ST, APT C-1, ORANGE, NJ 07050-3326
(973) 609-0117
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
307782
NY
Other
Enumeration date
05/21/2012
Last updated
05/21/2012
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