Provider Demographics
NPI:1972946309
Name:BADRU, MARY (RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BADRU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:KEANSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07734-1235
Mailing Address - Country:US
Mailing Address - Phone:732-670-2478
Mailing Address - Fax:
Practice Address - Street 1:76 BAYVIEW AVE
Practice Address - Street 2:
Practice Address - City:KEANSBURG
Practice Address - State:NJ
Practice Address - Zip Code:07734-1235
Practice Address - Country:US
Practice Address - Phone:732-670-2478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR09797400163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology