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General NPI Number Information
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NPI Number | 1972634996
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Entity Type | Individual
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Provider Name | ELLEN R DICHIARA APN-C
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Gender | Female
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 03/22/2011
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Provider Practice Location Address
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Address Line | 349 PASSAIC AVE
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City | NUTLEY
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State | NJ
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Zip | 07110-2738
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Country | US
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Telephone | 973-667-8889
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Fax |
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Provider Business Mailing Address
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Address Line | 76 MONONA AVE
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City | RUTHERFORD
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State | NJ
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Zip | 07070-1012
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Country | US
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Telephone | 201-314-5525
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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 | 26NJ00075400
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License Number State | NJ
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