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General NPI Number Information
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NPI Number | 1861660110
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Entity Type | Individual
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Provider Name | NICHOLE REID CRNP
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Gender | Female
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Dates
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Enumeration Date | 02/20/2008
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 175 MADISON AVE FL 1
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City | MOUNT HOLLY
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State | NJ
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Zip | 08060-2099
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Country | US
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Telephone | 609-914-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 SPRUCE ST GROUND FLOOR DULLES
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4206
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Country | US
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Telephone | 215-662-3005
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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 | SP009748
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ00331600
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License Number State | NJ
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