Provider Demographics
NPI:1144909540
Name:RAYMUNDO, HARRIET AVILA (APN)
Entity type:Individual
Prefix:
First Name:HARRIET
Middle Name:AVILA
Last Name:RAYMUNDO
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 1:6 SHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-1815
Mailing Address - Country:US
Mailing Address - Phone:917-280-8723
Mailing Address - Fax:
Practice Address - Street 1:6 SHERWOOD RD
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-1815
Practice Address - Country:US
Practice Address - Phone:917-280-8723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311258363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health