Healthcare Provider Details

I. General information

NPI: 1841822343
Provider Name (Legal Business Name): MICHELLE LYNN JUCKETT APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE LYNN STEVENSON

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 S BLACK HORSE PIKE
WILLIAMSTOWN NJ
08094-9247
US

IV. Provider business mailing address

76 MILL ST
MEDFORD NJ
08055-9301
US

V. Phone/Fax

Practice location:
  • Phone: 973-661-8300
  • Fax: 973-661-8333
Mailing address:
  • Phone: 609-790-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ01013400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: