Healthcare Provider Details

I. General information

NPI: 1306389689
Provider Name (Legal Business Name): LAUREN MICHELLE PELLICANE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2016
Last Update Date: 11/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 S COOKS BRIDGE RD SUITE 2-1
JACKSON NJ
08527-2524
US

IV. Provider business mailing address

27 S COOKS BRIDGE RD. SUITE 2-1
JACKSON NJ
08527
US

V. Phone/Fax

Practice location:
  • Phone: 732-367-0166
  • Fax:
Mailing address:
  • Phone: 732-367-0166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00681500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: