Provider Demographics
NPI:1669258596
Name:VERZOSA, MARIA VIDA MONTANIEL (APN)
Entity type:Individual
Prefix:
First Name:MARIA VIDA
Middle Name:MONTANIEL
Last Name:VERZOSA
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 1:605 GROVE ST APT E8
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3869
Mailing Address - Country:US
Mailing Address - Phone:917-957-9181
Mailing Address - Fax:
Practice Address - Street 1:605 GROVE ST APT E8
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3869
Practice Address - Country:US
Practice Address - Phone:917-957-9181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14912900363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care