Provider Demographics
NPI:1396375564
Name:EMERICH, DEIDRE EVELYN (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:DEIDRE
Middle Name:EVELYN
Last Name:EMERICH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 EWING ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-2757
Mailing Address - Country:US
Mailing Address - Phone:609-759-8500
Mailing Address - Fax:609-759-8501
Practice Address - Street 1:601 EWING ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-2757
Practice Address - Country:US
Practice Address - Phone:609-759-8500
Practice Address - Fax:609-759-8501
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025638363LF0000X
NJ26NJ01006000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ01006000OtherDIVISION OF CONSUMER AFFAIRS