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General NPI Number Information
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NPI Number | 1457017816
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Entity Type | Individual
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Provider Name | THIEL NICOLE HENNESSY APN
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Gender | Female
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Dates
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Enumeration Date | 11/10/2021
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 735 N BEERS ST
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City | HOLMDEL
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State | NJ
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Zip | 07733-1515
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Country | US
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Telephone | 732-739-5900
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Fax | 732-922-6026
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Provider Business Mailing Address
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Address Line | 331 NEWMAN SPRINGS RD STE 220
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City | RED BANK
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State | NJ
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Zip | 07701-5792
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Country | US
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Telephone | 732-807-0877
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Fax | 201-751-1680
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26NJ01167900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 26NJ01167900
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License Number State | NJ
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