Individual
JANCY CIVICHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
258 N NEW RD, PLEASANTVILLE, NJ 08232
(732) 743-5910
(732) 994-6993
Mailing address
258 N NEW RD, PLEASANTVILLE, NJ 08232-2170
(732) 743-5910
(732) 994-6993
Taxonomy
Speciality
Code
Description
License number
State
163WG0600X
Gerontology Registered Nurse
26NJ00812700
NJ
363LA2200X
Adult Health Nurse Practitioner
Primary
26NJ00812700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26NJ00812700
STATE LICENSE
NJ
Enumeration date
07/03/2018
Last updated
11/13/2018
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