Provider Demographics
NPI:1790023570
Name:PACHECO, BASILISA (ANP-BC)
Entity Type:Individual
Prefix:
First Name:BASILISA
Middle Name:
Last Name:PACHECO
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 BROWERTOWN RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2671
Mailing Address - Country:US
Mailing Address - Phone:973-785-7515
Mailing Address - Fax:
Practice Address - Street 1:205 BROWERTOWN RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-2671
Practice Address - Country:US
Practice Address - Phone:973-785-7515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO12217900363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health