Individual
MICCAL A. SCOTT-LYEW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGPC-NP
Contact information
Practice address
28 VALLEY RD # 148, MONTCLAIR, NJ 07042-2709
(973) 559-4600
(855) 998-4358
Mailing address
34 MOUNTAIN BLVD STE 203, WARREN, NJ 07059-2640
(908) 574-1267
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
26NJO1148500
NJ
Other
Enumeration date
03/08/2021
Last updated
07/07/2023
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