Provider Demographics
NPI:1063091338
Name:BATHAN, LEOMINDA MODALES (RN)
Entity type:Individual
Prefix:
First Name:LEOMINDA
Middle Name:MODALES
Last Name:BATHAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 ROUTE 206
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-4781
Mailing Address - Country:US
Mailing Address - Phone:908-685-2453
Mailing Address - Fax:908-595-2605
Practice Address - Street 1:331 ROUTE 206
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4781
Practice Address - Country:US
Practice Address - Phone:908-685-2453
Practice Address - Fax:908-595-2605
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO05521200163WC3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation