Healthcare Provider Details

I. General information

NPI: 1114836574
Provider Name (Legal Business Name): NICHOLE LYN WEEMS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

994 W SHERMAN AVE BLDG 2
VINELAND NJ
08360-6937
US

IV. Provider business mailing address

994 W SHERMAN AVE BLDG 2
VINELAND NJ
08360-6937
US

V. Phone/Fax

Practice location:
  • Phone: 856-212-1730
  • Fax:
Mailing address:
  • Phone: 856-212-1730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15647900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: