Individual
LISA WYDRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3391 HIGHWAY 35, HAZLET, NJ 07730-1521
(732) 888-8299
Mailing address
3391 HIGHWAY 35, HAZLET, NJ 07730-1521
(732) 888-8299
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
26NJ00285700
NJ
363LF0000X
Family Nurse Practitioner
Primary
26NR09130100
NJ
Other
Enumeration date
02/15/2010
Last updated
01/24/2019
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