Provider Demographics
NPI:1538492129
Name:CIPOLLONE, LEANORE MARIE (APRN, BC)
Entity Type:Individual
Prefix:
First Name:LEANORE
Middle Name:MARIE
Last Name:CIPOLLONE
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 WHITE HORSE PIKE
Mailing Address - Street 2:STE 112
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1938
Mailing Address - Country:US
Mailing Address - Phone:856-547-0539
Mailing Address - Fax:856-547-3178
Practice Address - Street 1:155 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-2612
Practice Address - Country:US
Practice Address - Phone:856-478-4780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN08694800363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ008897Medicare UPIN