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General NPI Number Information
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NPI Number | 1215527874
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Entity Type | Individual
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Provider Name | NICOLE MARIE DOUGLAS APN
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Gender | Female
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Dates
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Enumeration Date | 01/19/2021
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Last Update Date | 01/19/2021
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Provider Practice Location Address
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Address Line | 415 ROUTE 24 STE E
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City | CHESTER
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State | NJ
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Zip | 07930-2920
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Country | US
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Telephone | 908-879-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 19 REDWOOD RD
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City | MARTINSVILLE
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State | NJ
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Zip | 08836-2373
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Country | US
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Telephone | 732-977-8506
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NJ01103800
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License Number State | NJ
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