Individual
KIM MARIE MYDOSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS,RN,APN,C
Contact information
Practice address
48 MAPLE ST, SUMMIT, NJ 07901-2536
(973) 479-2551
Mailing address
48 MAPLE ST, SUMMIT, NJ 07901-2536
(973) 479-2551
Taxonomy
Speciality
Code
Description
License number
State
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
Primary
NO088227
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6631304
—
NJ
Enumeration date
04/24/2008
Last updated
05/13/2008
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