Provider Demographics
NPI:1205916855
Name:MCALLISTER, NICOLE R (ANP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:MCALLISTER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 DIVISION AVE
Mailing Address - Street 2:
Mailing Address - City:HASBROUCK HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07604-1111
Mailing Address - Country:US
Mailing Address - Phone:201-995-4445
Mailing Address - Fax:
Practice Address - Street 1:27 DIVISION AVE
Practice Address - Street 2:
Practice Address - City:HASBROUCK HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07604-1111
Practice Address - Country:US
Practice Address - Phone:201-995-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00086200363L00000X
NY430280363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner