Provider Demographics
NPI:1902581176
Name:PAVIERA, MAGELENDE S (MSN, RN, AGNP-NC)
Entity Type:Individual
Prefix:
First Name:MAGELENDE
Middle Name:S
Last Name:PAVIERA
Suffix:
Gender:F
Credentials:MSN, RN, AGNP-NC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 AVIARY RD
Mailing Address - Street 2:
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08086-3838
Mailing Address - Country:US
Mailing Address - Phone:908-451-5521
Mailing Address - Fax:
Practice Address - Street 1:2848 S DELSEA DR STE 2C
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-7042
Practice Address - Country:US
Practice Address - Phone:856-794-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01289300363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner