Provider Demographics
NPI:1790059905
Name:VERDEFLOR, O'BELLA FUSINGAN
Entity Type:Individual
Prefix:MRS
First Name:O'BELLA
Middle Name:FUSINGAN
Last Name:VERDEFLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:O'BELLA
Other - Middle Name:SAMILLANO
Other - Last Name:FUSINGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 WATSON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-2572
Mailing Address - Country:US
Mailing Address - Phone:732-313-6060
Mailing Address - Fax:732-313-6060
Practice Address - Street 1:17 WATSON RD
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-2572
Practice Address - Country:US
Practice Address - Phone:732-313-6060
Practice Address - Fax:732-313-6060
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00350400363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health