Provider Demographics
NPI:1346855285
Name:RUFOLO, NATIA (APN)
Entity Type:Individual
Prefix:MRS
First Name:NATIA
Middle Name:
Last Name:RUFOLO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MRS
Other - First Name:NATIA
Other - Middle Name:
Other - Last Name:GAGUA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:36 FOREST DR APT C
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-4130
Mailing Address - Country:US
Mailing Address - Phone:347-971-2337
Mailing Address - Fax:
Practice Address - Street 1:14 RIDGEDALE AVE STE 103
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-1106
Practice Address - Country:US
Practice Address - Phone:973-295-6335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01048300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily