=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073795688
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE M HENDERSON-COLE MSN, APN-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2007
-----------------------------------------------------
Last Update Date | 06/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 765 ROUTE 70 E BLDG A
-----------------------------------------------------
City | MARLTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08053-2341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-797-4858
-----------------------------------------------------
Fax | 856-797-4785
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 765 ROUTE 70 E BLDG A
-----------------------------------------------------
City | MARLTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08053-2341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-797-4858
-----------------------------------------------------
Fax | 856-797-4785
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | NPPA043263
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 26NJ00148100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------