MEDICARE: NICOLE NIESCIERUK APN, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	26NJ15410500	NJ

General Provider Information

NPI Number	:	1205787025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE NIESCIERUK APN, RN

Provider Business Mailing Address
First Line	:	11 FRIAR WAY
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-5302
Country	:	US
Telephone Number	:	973-356-6341
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 FRIAR WAY
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-5302
Country	:	US
Telephone Number	:	973-356-6341
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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