Healthcare Provider Details

I. General information

NPI: 1679473284
Provider Name (Legal Business Name): LISA MARIE MCNELIA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2026
Last Update Date: 11/07/2026
Certification Date: 11/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 QUAIL RIDGE WAY
MICKLETON NJ
08056-1466
US

IV. Provider business mailing address

99 QUAIL RIDGE WAY
MICKLETON NJ
08056-1466
US

V. Phone/Fax

Practice location:
  • Phone: 856-357-6483
  • Fax:
Mailing address:
  • Phone: 856-357-6483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number390200000X
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: