Provider Demographics
NPI:1760840474
Name:PEREIRA, IVONNE R (APN)
Entity Type:Individual
Prefix:
First Name:IVONNE
Middle Name:R
Last Name:PEREIRA
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 1:616 RAMAPO RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-1804
Mailing Address - Country:US
Mailing Address - Phone:201-936-7098
Mailing Address - Fax:
Practice Address - Street 1:616 RAMAPO RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-1804
Practice Address - Country:US
Practice Address - Phone:201-936-7098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00616300363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner