Provider Demographics
NPI:1881887248
Name:RAVEN, LUISA A (RN MSN CS)
Entity type:Individual
Prefix:
First Name:LUISA
Middle Name:A
Last Name:RAVEN
Suffix:
Gender:F
Credentials:RN MSN CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 HUDSON TERRACE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2806
Mailing Address - Country:US
Mailing Address - Phone:201-871-2266
Mailing Address - Fax:
Practice Address - Street 1:399 HUDSON TERRACE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2806
Practice Address - Country:US
Practice Address - Phone:201-871-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26N006021700364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist