=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841015385
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIANA CAMPANELLA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2024
-----------------------------------------------------
Last Update Date | 03/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 420 FRONT ST
-----------------------------------------------------
City | ELMER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08318-2177
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-358-1500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 PEPPERTREE CT
-----------------------------------------------------
City | SEWELL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08080-2104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | SP031400
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------