Provider Demographics
NPI: | 1821085143 |
---|---|
Name: | CORRICE, MICHELE M (NP) |
Entity Type: | Individual |
Prefix: | |
First Name: | MICHELE |
Middle Name: | M |
Last Name: | CORRICE |
Suffix: | |
Gender: | F |
Credentials: | NP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 5740 BERKSHIRE VALLEY RD |
Mailing Address - Street 2: | |
Mailing Address - City: | OAK RIDGE |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 07438-9847 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 866-389-2727 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 5740 BERKSHIRE VALLEY RD |
Practice Address - Street 2: | |
Practice Address - City: | OAK RIDGE |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 07438-9847 |
Practice Address - Country: | US |
Practice Address - Phone: | 866-389-2727 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-10-03 |
Last Update Date: | 2020-07-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NJ | 26NN09366100 | 363L00000X, 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NJ | 8160007 | Medicaid | |
S71249 | Medicare UPIN | ||
NJ | 8160007 | Medicaid |