Healthcare Provider Details

I. General information

NPI: 1922580596
Provider Name (Legal Business Name): TERESA L MEROLA MSN,RN,PNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 LAUREL OAK RD
VOORHEES NJ
08043-4310
US

IV. Provider business mailing address

2106 NEW RD STE F1
LINWOOD NJ
08221-1053
US

V. Phone/Fax

Practice location:
  • Phone: 856-346-3300
  • Fax: 856-346-3462
Mailing address:
  • Phone: 609-926-5451
  • Fax: 609-926-5451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NJ00367500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: