Provider Demographics
NPI:1215559695
Name:RUTGERS, SCHOOL OF NURSING-CAMDEN COMMUNITY HEALTH CLINICS
Entity Type:Organization
Organization Name:RUTGERS, SCHOOL OF NURSING-CAMDEN COMMUNITY HEALTH CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEAN AND PROFESSOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKITAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:856-225-6876
Mailing Address - Street 1:530 FEDERAL STREET, NURSING & SCIENCE BUILDING
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08102
Mailing Address - Country:US
Mailing Address - Phone:856-225-6876
Mailing Address - Fax:
Practice Address - Street 1:THE BRANCHES HEALTH CENTER
Practice Address - Street 2:1700 SOUTH 9TH STREET
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08104
Practice Address - Country:US
Practice Address - Phone:856-225-2983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty