Provider Demographics
NPI:1649987447
Name:QOSE, PRANVERA (DNP)
Entity type:Individual
Prefix:DR
First Name:PRANVERA
Middle Name:
Last Name:QOSE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SCALZA LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07035-2019
Mailing Address - Country:US
Mailing Address - Phone:973-870-1442
Mailing Address - Fax:
Practice Address - Street 1:15 SCALZA LN
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:NJ
Practice Address - Zip Code:07035-2019
Practice Address - Country:US
Practice Address - Phone:973-870-1442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01374300363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care