MEDICARE: MONIKA K NIEMIEC APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	26NJ00971000	NJ
2	363LP2300X	Primary Care Nurse Practitioner	26NJ00971000	NJ
3	363LA2200X	Adult Health Nurse Practitioner	26NJ00971000	NJ

General Provider Information

NPI Number	:	1407492879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIKA K NIEMIEC APN

Provider Business Mailing Address
First Line	:	535 MIDLAND AVE
Second Line	:
City	:	GARFIELD
State	:	NJ
Zip	:	07026-1658
Country	:	US
Telephone Number	:	973-340-1182
Fax Number	:

Provider Business Practice Location Address
First Line	:	535 MIDLAND AVE
Second Line	:
City	:	GARFIELD
State	:	NJ
Zip	:	07026-1658
Country	:	US
Telephone Number	:	973-340-1182
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2019
Last Update Date	:	03/18/2021

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