Provider Demographics
NPI:1790922797
Name:RAVEN, NICOLE ZANDER (AUD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ZANDER
Last Name:RAVEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:BUSH
Other - Last Name:RAVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1843 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-2115
Mailing Address - Country:US
Mailing Address - Phone:215-629-1353
Mailing Address - Fax:215-629-1395
Practice Address - Street 1:6 SAND HILL RD STE 302
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822
Practice Address - Country:US
Practice Address - Phone:908-788-9131
Practice Address - Fax:908-788-0945
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00096400237600000X
DEO2-0000124231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist