Provider Demographics
NPI:1306691548
Name:PATEL, MAMTA S (DNP, APN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MAMTA
Middle Name:S
Last Name:PATEL
Suffix:
Gender:F
Credentials:DNP, APN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PRIDES XING
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1147
Mailing Address - Country:US
Mailing Address - Phone:848-219-9721
Mailing Address - Fax:
Practice Address - Street 1:2 PRIDES XING
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1147
Practice Address - Country:US
Practice Address - Phone:848-219-9721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15026300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily