Provider Demographics
NPI:1023851805
Name:OSIFO, EHIMWENMA CONSTANCE (MSN)
Entity type:Individual
Prefix:
First Name:EHIMWENMA
Middle Name:CONSTANCE
Last Name:OSIFO
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485C US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-3037
Mailing Address - Country:US
Mailing Address - Phone:201-993-7930
Mailing Address - Fax:
Practice Address - Street 1:485C US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-3037
Practice Address - Country:US
Practice Address - Phone:201-993-7930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR15055500163WC0400X
NJ26NJ15126300363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management