Provider Demographics
NPI:1689752016
Name:MINISCHETTI, MARYANNE (RN APNC PHD)
Entity Type:Individual
Prefix:
First Name:MARYANNE
Middle Name:
Last Name:MINISCHETTI
Suffix:
Gender:F
Credentials:RN APNC PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 W END AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-1809
Mailing Address - Country:US
Mailing Address - Phone:908-333-4008
Mailing Address - Fax:
Practice Address - Street 1:270 DAVIDSON AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-4140
Practice Address - Country:US
Practice Address - Phone:732-328-2639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC07289800363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ527486OtherAGENCY PTAN #
NJ0023701Medicaid
NJ527486OtherAGENCY PTAN #
NJ0023701Medicaid