Provider Demographics
NPI:1902573389
Name:ENGUTAN, JUNA BOLLESER (APN)
Entity Type:Individual
Prefix:
First Name:JUNA
Middle Name:BOLLESER
Last Name:ENGUTAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 PENNINGTON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-2669
Mailing Address - Country:US
Mailing Address - Phone:609-890-1050
Mailing Address - Fax:
Practice Address - Street 1:1440 PENNINGTON RD STE 1
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-2669
Practice Address - Country:US
Practice Address - Phone:609-890-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01170800363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care