Healthcare Provider Details

I. General information

NPI: 1467046292
Provider Name (Legal Business Name): MARILOU NAKLICKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 NEWARK POMPTON TPKE
LITTLE FALLS NJ
07424-1112
US

IV. Provider business mailing address

188 NEWARK POMPTON TPKE
LITTLE FALLS NJ
07424-1112
US

V. Phone/Fax

Practice location:
  • Phone: 877-887-3574
  • Fax: 862-279-7580
Mailing address:
  • Phone: 877-887-3574
  • Fax: 862-279-7580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: