Provider Demographics
NPI:1811772791
Name:MEJIA, MARITZA (REGISTER NURSE)
Entity type:Individual
Prefix:
First Name:MARITZA
Middle Name:
Last Name:MEJIA
Suffix:
Gender:F
Credentials:REGISTER NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 WAINWRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4713
Mailing Address - Country:US
Mailing Address - Phone:631-235-6058
Mailing Address - Fax:
Practice Address - Street 1:498 ROUTE 111
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4732
Practice Address - Country:US
Practice Address - Phone:631-235-6058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR22622300163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse