Provider Demographics
NPI:1447627112
Name:AGHANWA, RITA NWAKAUSO (FNP)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:NWAKAUSO
Last Name:AGHANWA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646
Mailing Address - Country:US
Mailing Address - Phone:201-225-2101
Mailing Address - Fax:201-225-2101
Practice Address - Street 1:880 RIVER ROAD
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646-3097
Practice Address - Country:US
Practice Address - Phone:201-225-2101
Practice Address - Fax:201-225-2101
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-28
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00580200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily