Individual
MS. IDALISSIE ALTAGRACIA PEGUERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN, PMHNPBC
Contact information
Practice address
550 BROAD ST STE 606, NEWARK, NJ 07102-4537
(201) 822-1161
(877) 485-8918
Mailing address
606 BROADWAY, PATERSON, NJ 07514-1916
(973) 523-4000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
26NJ00838200
NJ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
26NJ00838200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0655881
—
NJ
Enumeration date
08/20/2018
Last updated
10/10/2024
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