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General NPI Number Information
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NPI Number | 1841822343
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Entity Type | Individual
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Provider Name | MICHELLE LYNN JUCKETT APN
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Gender | Female
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Dates
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Enumeration Date | 02/12/2020
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 1640 S BLACK HORSE PIKE
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City | WILLIAMSTOWN
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State | NJ
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Zip | 08094-9247
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Country | US
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Telephone | 973-661-8300
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Fax | 973-661-8333
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Provider Business Mailing Address
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Address Line | 76 MILL ST
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City | MEDFORD
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State | NJ
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Zip | 08055-9301
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Country | US
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Telephone | 609-790-1111
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 26NJ01013400
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License Number State | NJ
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