Provider Demographics
NPI:1275941205
Name:CREADLE, JOSEPH (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:CREADLE
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MAIN STREET SUITE 30-2
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753
Mailing Address - Country:US
Mailing Address - Phone:732-213-3834
Mailing Address - Fax:732-998-8341
Practice Address - Street 1:30 MAIN STREET SUITE 30-2
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753
Practice Address - Country:US
Practice Address - Phone:732-213-3834
Practice Address - Fax:732-998-8341
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR12373600163WH0200X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No253Z00000XAgenciesIn Home Supportive Care