Provider Demographics
NPI:1730452095
Name:BROTHERS, NANCY W (RN)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:W
Last Name:BROTHERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:M
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1828 LUDLOW STREET
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-3548
Mailing Address - Country:US
Mailing Address - Phone:732-306-9945
Mailing Address - Fax:
Practice Address - Street 1:151 SUMMIT AVENUE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901
Practice Address - Country:US
Practice Address - Phone:908-377-1963
Practice Address - Fax:973-635-1769
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR06371900163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse