Provider Demographics
NPI:1629353404
Name:RAYMOND, FATMATA (APN)
Entity Type:Individual
Prefix:
First Name:FATMATA
Middle Name:
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 JENNIFER LN
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-1142
Mailing Address - Country:US
Mailing Address - Phone:571-277-6003
Mailing Address - Fax:
Practice Address - Street 1:98 JENNIFER LN
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-1142
Practice Address - Country:US
Practice Address - Phone:571-277-6003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR15442100163W00000X
NJ26NJ01344100363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse