Provider Demographics
NPI:1386266179
Name:MILETTI, KIMBERLY A (APN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:MILETTI
Suffix:
Gender:
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32-02 HILLSIDE TER
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-4253
Mailing Address - Country:US
Mailing Address - Phone:201-280-2007
Mailing Address - Fax:
Practice Address - Street 1:290 LAFAYETTE AVE STE 202
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-1928
Practice Address - Country:US
Practice Address - Phone:973-363-4850
Practice Address - Fax:973-363-4606
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01021100363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology