Provider Demographics
NPI:1679859391
Name:MAYETTE, NIKKI LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NIKKI
Middle Name:LYNN
Last Name:MAYETTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:NIKKI
Other - Middle Name:LYNN
Other - Last Name:SERGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:301 S MAIN ST
Mailing Address - Street 2:SUITE 2 SOUTH
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-4870
Mailing Address - Country:US
Mailing Address - Phone:215-348-4478
Mailing Address - Fax:215-348-2452
Practice Address - Street 1:301 S MAIN ST
Practice Address - Street 2:SUITE 2 SOUTH
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-4870
Practice Address - Country:US
Practice Address - Phone:215-348-4478
Practice Address - Fax:215-348-2452
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055147363AM0700X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical