Provider Demographics
NPI:1700758026
Name:MAYSONET, ANGELICA LUZ (LPN)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:LUZ
Last Name:MAYSONET
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BRANCH BROOK DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3601
Mailing Address - Country:US
Mailing Address - Phone:862-417-7963
Mailing Address - Fax:
Practice Address - Street 1:29 BRANCH BROOK DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3601
Practice Address - Country:US
Practice Address - Phone:862-417-7963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP07795100164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse