Provider Demographics
NPI:1841834488
Name:RAJAN, MAUJA VENUGOPAL (CNP)
Entity type:Individual
Prefix:
First Name:MAUJA
Middle Name:VENUGOPAL
Last Name:RAJAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:MAUJA
Other - Middle Name:CHOOLAKKAL
Other - Last Name:VENUGOPAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAUJA C VENUGOPAL
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-441-1949
Mailing Address - Fax:740-446-5982
Practice Address - Street 1:100 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:740-441-1949
Practice Address - Fax:740-446-5982
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH025724363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily