Provider Demographics
NPI:1053423418
Name:ANSELMO, PATRICIA ANN (RN, APN,C)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:ANSELMO
Suffix:
Gender:F
Credentials:RN, APN,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 CRANBURY RD
Mailing Address - Street 2:SUITE #90
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4098
Mailing Address - Country:US
Mailing Address - Phone:732-257-0081
Mailing Address - Fax:
Practice Address - Street 1:620 CRANBURY RD
Practice Address - Street 2:SUITE #90
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4098
Practice Address - Country:US
Practice Address - Phone:732-257-0081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNO06391700363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2660356OtherCIGNA
NJ22-1487330-255OtherQUAL CARE
NJ2660356OtherCIGNA