Healthcare Provider Details

I. General information

NPI: 1922728633
Provider Name (Legal Business Name): MICHELLE LYNN PANDOLA APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6106 BLACK HORSE PIKE
EGG HARBOR TOWNSHIP NJ
08234-9701
US

IV. Provider business mailing address

6106 BLACK HORSE PIKE
EGG HARBOR TOWNSHIP NJ
08234-9701
US

V. Phone/Fax

Practice location:
  • Phone: 609-645-7847
  • Fax:
Mailing address:
  • Phone: 609-645-7847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NJ01356400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: