Individual
MRS. KIERSTEN ILAOA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
765 ROUTE 70 E, MARLTON, NJ 08053-2341
(856) 983-3900
Mailing address
765 ROUTE 70 E, MARLTON, NJ 08053-2341
(856) 983-3900
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
26NJ00952100
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/02/2019
Last updated
04/23/2021
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