Healthcare Provider Details

I. General information

NPI: 1730377102
Provider Name (Legal Business Name): HEATHER POBLETE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 KUSER RD SUITE 4
HAMILTON NJ
08619-3823
US

IV. Provider business mailing address

1345 KUSER RD SUITE 4
HAMILTON NJ
08619-3823
US

V. Phone/Fax

Practice location:
  • Phone: 609-581-1878
  • Fax: 609-581-2632
Mailing address:
  • Phone: 609-581-1878
  • Fax: 609-581-2632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number304707
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number26NJ00425800
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NR16474300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: