Provider Demographics
NPI:1851377832
Name:NIETO, MONICA (RN,APN)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:NIETO
Suffix:
Gender:F
Credentials:RN,APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-4514
Mailing Address - Country:US
Mailing Address - Phone:609-394-4111
Mailing Address - Fax:609-394-4070
Practice Address - Street 1:433 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-4501
Practice Address - Country:US
Practice Address - Phone:609-394-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN04671800363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6747400Medicaid
NJ6747400Medicaid
S66612Medicare UPIN