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General NPI Number Information
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NPI Number | 1174720296
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Entity Type | Individual
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Provider Name | REBECCA NILSEN D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/02/2007
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 655 SHREWSBURY AVE
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City | SHREWSBURY
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State | NJ
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Zip | 07702-4179
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Country | US
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Telephone | 732-945-3912
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Fax |
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Provider Business Mailing Address
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Address Line | 655 SHREWSBURY AVE
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City | SHREWSBURY
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State | NJ
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Zip | 07702-4179
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Country | US
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Telephone | 732-945-3921
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 25MB08843000
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License Number State | NJ
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