Healthcare Provider Details

I. General information

NPI: 1538492129
Provider Name (Legal Business Name): LEANORE MARIE CIPOLLONE APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N MAIN ST
MULLICA HILL NJ
08062-2612
US

IV. Provider business mailing address

120 WHITE HORSE PIKE STE 112
HADDON HEIGHTS NJ
08035-1938
US

V. Phone/Fax

Practice location:
  • Phone: 856-478-4780
  • Fax:
Mailing address:
  • Phone: 856-547-0539
  • Fax: 856-547-3178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NN08694800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: