Provider Demographics
NPI:1447749262
Name:BEJIAN, NICOLE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BEJIAN
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 1:21 MOHAWK AVE
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1808
Mailing Address - Country:US
Mailing Address - Phone:973-729-4211
Mailing Address - Fax:
Practice Address - Street 1:21 MOHAWK AVE
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1808
Practice Address - Country:US
Practice Address - Phone:973-729-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2024-02-02
Deactivation Date:2024-01-25
Deactivation Code:
Reactivation Date:2024-02-02
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00818700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily