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: | 1 FEDERAL ST STE 200 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | CAMDEN |
| Mailing Address - State: | NJ |
| Mailing Address - Zip Code: | 08103-1088 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 848-288-6935 |
| Mailing Address - Fax: | 732-790-0107 |
| Practice Address - Street 1: | 175 ROUTE 130 S |
| Practice Address - Street 2: | |
| Practice Address - City: | CINNAMINSON |
| Practice Address - State: | NJ |
| Practice Address - Zip Code: | 08077-3376 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 856-536-1640 |
| Practice Address - Fax: | |
| Is Sole Proprietor?: | No |
| Enumeration Date: | 2005-08-11 |
| Last Update Date: | 2025-03-06 |
| Deactivation Date: | 2022-10-17 |
| Deactivation Code: | |
| Reactivation Date: | 2022-11-10 |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| NJ | 26NN08547000 | 363LF0000X, 363L00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NJ | 0372366 | Medicaid | |
| NJ | 086168N4X | Medicare PIN |