Provider Demographics
NPI:1073794244
Name:CANUBIDA, AMELITA ESCALONA (NP-C)
Entity Type:Individual
Prefix:
First Name:AMELITA
Middle Name:ESCALONA
Last Name:CANUBIDA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NEWARK INTERNATIONAL AIRPORT, TERMINAL C
Mailing Address - Street 2:ROOM 136
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07114
Mailing Address - Country:US
Mailing Address - Phone:973-681-1700
Mailing Address - Fax:
Practice Address - Street 1:NEWARK INTERNATIONAL AIRPORT, TERMINAL C
Practice Address - Street 2:ROOM 136
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07114
Practice Address - Country:US
Practice Address - Phone:973-681-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00145200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health