MEDICARE: NICOLE WARES APN

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	363LA2100X	Acute Care Nurse Practitioner	26NJ00844000	NJ

General Provider Information

NPI Number	:	1588131551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE WARES APN

Provider Business Mailing Address
First Line	:	375 MOUNT PLEASANT AVE
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-2750
Country	:	US
Telephone Number	:	973-731-9442
Fax Number	:	973-587-8153

Provider Business Practice Location Address
First Line	:	5 FRANKLIN AVE STE 202
Second Line	:
City	:	BELLEVILLE
State	:	NJ
Zip	:	07109-3521
Country	:	US
Telephone Number	:	973-429-8333
Fax Number	:	973-450-8157

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

Provider Enumeration Date	:	10/29/2018
Last Update Date	:	10/29/2018

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