Provider Demographics
NPI:1114515822
Name:PICKETT, BIANCA CHANEL
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:CHANEL
Last Name:PICKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 MOUNT PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-4008
Mailing Address - Country:US
Mailing Address - Phone:973-666-7470
Mailing Address - Fax:
Practice Address - Street 1:54 MOUNT PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-4008
Practice Address - Country:US
Practice Address - Phone:973-666-7470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula