Provider Demographics
NPI:1730895558
Name:IGHODARO, IYEN STACEY (DNP, FNP-BC, FNP-C)
Entity type:Individual
Prefix:DR
First Name:IYEN
Middle Name:STACEY
Last Name:IGHODARO
Suffix:
Gender:F
Credentials:DNP, FNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-3648
Mailing Address - Country:US
Mailing Address - Phone:646-633-1525
Mailing Address - Fax:
Practice Address - Street 1:197 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3648
Practice Address - Country:US
Practice Address - Phone:646-633-1525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01426300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily