Provider Demographics
NPI: | 1306848288 |
---|---|
Name: | IWU, EMILIA N (APNC) |
Entity type: | Individual |
Prefix: | |
First Name: | EMILIA |
Middle Name: | N |
Last Name: | IWU |
Suffix: | |
Gender: | F |
Credentials: | APNC |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1 FEDERAL ST STE 200 |
Mailing Address - Street 2: | |
Mailing Address - City: | CAMDEN |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08103-1088 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 848-288-6935 |
Mailing Address - Fax: | 732-790-0107 |
Practice Address - Street 1: | 175 ROUTE 130 S |
Practice Address - Street 2: | |
Practice Address - City: | CINNAMINSON |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08077-3376 |
Practice Address - Country: | US |
Practice Address - Phone: | 856-536-1640 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-08-11 |
Last Update Date: | 2025-03-06 |
Deactivation Date: | 2022-10-17 |
Deactivation Code: | |
Reactivation Date: | 2022-11-10 |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NJ | 26NN08547000 | 363LF0000X, 363L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NJ | 0372366 | Medicaid | |
NJ | 086168N4X | Medicare PIN |