Provider Demographics
NPI:1659871572
Name:MYERS, NICOLE M (CNM)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:M
Last Name:MYERS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2734 MONMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:JOBSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08041
Mailing Address - Country:US
Mailing Address - Phone:609-668-4146
Mailing Address - Fax:609-737-0978
Practice Address - Street 1:2 TREE FARM ROAD
Practice Address - Street 2:SUITE A110
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534
Practice Address - Country:US
Practice Address - Phone:609-737-7512
Practice Address - Fax:609-737-0978
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR17989500163W00000X
NJ25ME00064000367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse