Provider Demographics
NPI:1003687591
Name:NEAL-MINK, CHEVON ALEASE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:CHEVON
Middle Name:ALEASE
Last Name:NEAL-MINK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:CHEVON
Other - Middle Name:ALEASE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:848-288-6935
Mailing Address - Fax:
Practice Address - Street 1:500 BERLIN CROSS KEYS RD
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-4355
Practice Address - Country:US
Practice Address - Phone:856-536-1536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14942400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily