Basic Information
| Provider Information | |||||||||
| NPI: | 1699448688 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | URENA | ||||||||
| FirstName: | MINDI | ||||||||
| MiddleName: | BETH | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 52 SCENIC CT | ||||||||
| Address2: | |||||||||
| City: | HACKETTSTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078401745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2014468186 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 89 SPARTA AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | SPARTA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078711790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737267220 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2021 | ||||||||
| LastUpdateDate: | 03/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 26NJ01158700 | NJ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | 26NR15840400 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 26NJ01158700 | 01 | NJ | NJ BOARD OF NURSING APN LICENSE | OTHER |