Individual
ROBERTA F MENNIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
22 JENNIFER DR, HOWELL, NJ 07731-2367
(732) 367-6131
Mailing address
637 RIVER AVE, LAKEWOOD, NJ 08701-5227
(732) 886-9101
(732) 886-9523
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
26NJ00057700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0062472
—
NJ
Enumeration date
02/22/2006
Last updated
04/29/2009
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