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General NPI Number Information
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NPI Number | 1245082197
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Entity Type | Individual
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Provider Name | JUNIELLE-ANN RICKETTS FNP-C
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Gender | Female
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Dates
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Enumeration Date | 04/03/2024
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Last Update Date | 04/03/2024
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Provider Practice Location Address
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Address Line | 741 BROADWAY
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City | NEWARK
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State | NJ
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Zip | 07104-4309
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Country | US
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Telephone | 973-674-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 7 SAINT ANDREWS DR
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City | WASHINGTON
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State | NJ
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Zip | 07882-1562
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Country | US
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Telephone | 862-202-0222
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ15003500
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License Number State | NJ
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