Healthcare Provider Details

I. General information

NPI: 1669384996
Provider Name (Legal Business Name): MS. NICOLE RENAUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 GLENN AVE
EGG HARBOR TOWNSHIP NJ
08234-6109
US

IV. Provider business mailing address

18 COOPER DR
SOMERS POINT NJ
08244-1608
US

V. Phone/Fax

Practice location:
  • Phone: 877-504-4141
  • Fax:
Mailing address:
  • Phone: 609-402-5687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: