Provider Demographics
NPI:1508292525
Name:LANNEAUX, PAULETTE TAKA (NP)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:TAKA
Last Name:LANNEAUX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 BELMONT AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-1018
Mailing Address - Country:US
Mailing Address - Phone:973-751-7870
Mailing Address - Fax:973-751-7875
Practice Address - Street 1:140 BELMONT AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-1018
Practice Address - Country:US
Practice Address - Phone:973-751-7870
Practice Address - Fax:973-751-7875
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00443400363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner