Provider Demographics
NPI:1306848288
Name:IWU, EMILIA N (APNC)
Entity Type:Individual
Prefix:
First Name:EMILIA
Middle Name:N
Last Name:IWU
Suffix:
Gender:F
Credentials:APNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 YALE RD
Mailing Address - Street 2:
Mailing Address - City:ATCO
Mailing Address - State:NJ
Mailing Address - Zip Code:08004-2243
Mailing Address - Country:US
Mailing Address - Phone:856-767-1769
Mailing Address - Fax:856-767-1769
Practice Address - Street 1:238 E BROADWAY
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079-1108
Practice Address - Country:US
Practice Address - Phone:856-935-7711
Practice Address - Fax:856-935-9123
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2022-11-10
Deactivation Date:2022-10-17
Deactivation Code:
Reactivation Date:2022-11-10
Provider Licenses
StateLicense IDTaxonomies
NJ26NN08547000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0372366Medicaid
NJ086168N4XMedicare PIN