Provider Demographics
NPI:1649758566
Name:FERNICOLA, KRIS ANN
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:ANN
Last Name:FERNICOLA
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 1:30 BERKLEY CT
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2426
Mailing Address - Country:US
Mailing Address - Phone:973-789-6523
Mailing Address - Fax:
Practice Address - Street 1:573 VALLEY RD STE 6
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3552
Practice Address - Country:US
Practice Address - Phone:973-500-4018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other