Provider Demographics
NPI:1477160836
Name:DENDULK, ALEXA (FNP-C, APN)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:DENDULK
Suffix:
Gender:F
Credentials:FNP-C, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-1400
Mailing Address - Country:US
Mailing Address - Phone:973-248-5918
Mailing Address - Fax:
Practice Address - Street 1:65 RIDGEDALE AVE
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-1313
Practice Address - Country:US
Practice Address - Phone:973-401-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01061400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily