Provider Demographics
NPI:1477138378
Name:ENABOSI, PATIENCE (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:PATIENCE
Middle Name:
Last Name:ENABOSI
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 CENTRAL AVE STE 607D
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-3332
Mailing Address - Country:US
Mailing Address - Phone:732-857-1978
Mailing Address - Fax:
Practice Address - Street 1:117 POND AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:NJ
Practice Address - Zip Code:08846-2218
Practice Address - Country:US
Practice Address - Phone:862-216-9966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2024087196363LP0808X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No251E00000XAgenciesHome Health