Healthcare Provider Details

I. General information

NPI: 1003941972
Provider Name (Legal Business Name): NANCY S REDEKER PH.D., R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 BERGEN ST RM 1122 UMDNJ SCHOOL OF NURSING
NEWARK NJ
07107-3001
US

IV. Provider business mailing address

664 PALISADE RD
UNION NJ
07083-7711
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-3875
  • Fax: 973-972-7853
Mailing address:
  • Phone: 908-354-2706
  • Fax: 908-354-2706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN073356
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: