Individual provider · Type 1 NPI
Idalissie Altagracia Peguero, APN, PMHNPBC
Psychiatric/Mental Health Nurse Practitioner · Newark, NJ
NPI number
1689154437
Active
Practice location
550 Broad St Ste 606
Newark, NJ 07102-4537
Fax (877) 485-8918
Mailing address
606 Broadway
Paterson, NJ 07514-1916
Other practice locations
- 606 Broadway, Paterson, NJ 07514-1916 · (973) 523-4000
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner | 363L00000X | 26NJ00838200 (NJ) |
| Psychiatric/Mental Health Nurse Practitioner Primary | 363LP0808X | 26NJ00838200 (NJ) |
Psychiatric/Mental Health Nurse Practitioner: Definition to come...
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About NPI 1689154437
Idalissie Altagracia Peguero, APN, PMHNPBC's National Provider Identifier is 1689154437, issued on Aug 20, 2018. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in Newark, NJ. The record was last updated on Oct 10, 2024.