Provider Demographics
NPI:1598432882
Name:RAGHUNANDAN, ANDRIA P (RN)
Entity Type:Individual
Prefix:MRS
First Name:ANDRIA
Middle Name:P
Last Name:RAGHUNANDAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:ANDRIA
Other - Middle Name:P
Other - Last Name:RAGHUNANDAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:45 BROADMAN PKWY
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-1547
Mailing Address - Country:US
Mailing Address - Phone:201-401-7323
Mailing Address - Fax:
Practice Address - Street 1:308 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-3808
Practice Address - Country:US
Practice Address - Phone:201-401-7323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO10811200163WC0200X
NJ26NJ01185600363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine