Healthcare Provider Details

I. General information

NPI: 1750171989
Provider Name (Legal Business Name): LORI ANN NIXON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23659 COLUMBUS RD
COLUMBUS NJ
08022-1980
US

IV. Provider business mailing address

10 HUNTER DR
BURLINGTON NJ
08016-9788
US

V. Phone/Fax

Practice location:
  • Phone: 609-298-3304
  • Fax:
Mailing address:
  • Phone: 609-902-7095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26NJ15254100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ15254100
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15254100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: