Provider Demographics
NPI:1770656274
Name:LINES DEGELMAN, HEATHER (RN APNC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:LINES DEGELMAN
Suffix:
Gender:F
Credentials:RN APNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 A EYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SUCCUSUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1168
Mailing Address - Country:US
Mailing Address - Phone:973-252-1526
Mailing Address - Fax:
Practice Address - Street 1:8000 FELLOWSHIP RD
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-3915
Practice Address - Country:US
Practice Address - Phone:908-580-3822
Practice Address - Fax:908-647-2953
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN08813500363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S46943Medicare UPIN
NJ003989Medicare ID - Type Unspecified
NJ500015521Medicare PIN