Healthcare Provider Details

I. General information

NPI: 1932658887
Provider Name (Legal Business Name): KATHRYN NESCI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 W KENNEDY BLVD
LAKEWOOD NJ
08701-1224
US

IV. Provider business mailing address

16 LINDA LN
TINTON FALLS NJ
07724-2773
US

V. Phone/Fax

Practice location:
  • Phone: 732-370-1111
  • Fax:
Mailing address:
  • Phone: 732-618-4327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number26NJ00674400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: