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General NPI Number Information
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NPI Number | 1831595453
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Entity Type | Individual
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Provider Name | DEANNA TIKHONOV APN
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Gender | Female
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Dates
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Enumeration Date | 11/10/2014
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Last Update Date | 01/06/2016
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Provider Practice Location Address
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Address Line | 125 PATERSON STREET ACADEMIC BUILDING SUITE 4200
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-1977
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Country | US
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Telephone | 732-235-7755
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Fax |
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Provider Business Mailing Address
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Address Line | 125 PATERSON STREET CLINICAL ACADEMIC BUILDING SUITE 4200
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-1977
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Country | US
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Telephone |
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 26NJ00531400
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License Number State | NJ
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