Individual
SUSAN WIEDASECK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
201 LYONS AVE, NEWARK, NJ 07107
(973) 972-4249
Mailing address
PO BOX 640, BELLEVILLE, NJ 07109
(973) 759-8700
(973) 759-7545
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
25ME00013401
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2094207
—
NJ
Enumeration date
03/31/2006
Last updated
07/08/2007
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