Healthcare Provider Details

I. General information

NPI: 1154589877
Provider Name (Legal Business Name): NICOLE MARIA MEOLA RN, MS,RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE MARIA MEOLA-BURKE RN,MS,RNFA

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 W LAKE RD
MEDFORD NJ
08055-8105
US

IV. Provider business mailing address

15 W LAKE RD
MEDFORD NJ
08055-8105
US

V. Phone/Fax

Practice location:
  • Phone: 856-810-3970
  • Fax:
Mailing address:
  • Phone: 856-810-3970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberNO092853
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: