Individual
SANTA CRISALL
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
495 N 13TH ST, NEWARK, NJ 07107-1317
(973) 268-2492
Mailing address
222 KINDERKAMACK RD, ORADELL, NJ 07649-2259
(973) 268-2492
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
NN71590
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8459908
—
NJ
Enumeration date
05/24/2006
Last updated
09/25/2020
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