Healthcare Provider Details

I. General information

NPI: 1326153123
Provider Name (Legal Business Name): PATRICIA CLEARY WIELICZKO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 FRANKLIN CORNER ROAD SUITE 105
LAWRENCEVILLE NJ
08648
US

IV. Provider business mailing address

134 FRANKLIN CORNER ROAD SUITE 105
LAWRENCEVILLE NJ
08648
US

V. Phone/Fax

Practice location:
  • Phone: 609-613-6686
  • Fax: 215-321-1383
Mailing address:
  • Phone: 609-613-6686
  • Fax: 215-321-1383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number26NC07343000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: