Healthcare Provider Details

I. General information

NPI: 1114124203
Provider Name (Legal Business Name): NANCY C WHELAN RN,APN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LYONS AVE BUILDING L-5 PEDIATRIC GASTROENTEROLOGY
NEWARK NJ
07112-2026
US

IV. Provider business mailing address

1123 COOLIDGE RD
ELIZABETH NJ
07208-1005
US

V. Phone/Fax

Practice location:
  • Phone: 973-926-7280
  • Fax: 973-705-3148
Mailing address:
  • Phone: 908-355-0355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NO10834400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NN10834400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: