Provider Demographics
NPI:1235310012
Name:JENISCH, NICHOLE CECILIA (RN, APN,C)
Entity type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:CECILIA
Last Name:JENISCH
Suffix:
Gender:F
Credentials:RN, APN,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:1 HEALTH PLZ BLDG 315
Practice Address - Street 2:
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936-1016
Practice Address - Country:US
Practice Address - Phone:862-778-7960
Practice Address - Fax:973-791-6505
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00139200363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner