Provider Demographics
NPI:1659924314
Name:MENCHAVEZ, DANICA CAMILLE PANGANDOYON (RN)
Entity Type:Individual
Prefix:
First Name:DANICA CAMILLE
Middle Name:PANGANDOYON
Last Name:MENCHAVEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116-130 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055
Mailing Address - Country:US
Mailing Address - Phone:973-799-2865
Mailing Address - Fax:
Practice Address - Street 1:116-130 BROADWAY
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055
Practice Address - Country:US
Practice Address - Phone:973-779-2865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7660341163WS0200X
NJ26NR20210400163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WS0200XNursing Service ProvidersRegistered NurseSchool