Provider Demographics
NPI:1922005370
Name:DE NOIA, VICKI R (APN)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:R
Last Name:DE NOIA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 ROUTE 35
Mailing Address - Street 2:STE 300
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-2758
Mailing Address - Country:US
Mailing Address - Phone:732-531-5509
Mailing Address - Fax:732-531-5164
Practice Address - Street 1:71 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-2349
Practice Address - Country:US
Practice Address - Phone:732-741-3600
Practice Address - Fax:732-741-6079
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR03672000163W00000X
NJ26NJ00023500363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ068705CKUMedicare ID - Type UnspecifiedMEDICARE ID
P85862Medicare UPIN