Provider Demographics
NPI:1255397014
Name:SLACK, BABICHE MICHELE (RN, MS, APN-C)
Entity type:Individual
Prefix:MS
First Name:BABICHE
Middle Name:MICHELE
Last Name:SLACK
Suffix:
Gender:F
Credentials:RN, MS, APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 375
Mailing Address - Street 2:
Mailing Address - City:STOCKHOLM
Mailing Address - State:NJ
Mailing Address - Zip Code:07460-0375
Mailing Address - Country:US
Mailing Address - Phone:973-697-9269
Mailing Address - Fax:
Practice Address - Street 1:183 ROUTE 206 SOUTH
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:612-859-7101
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR0893590363LF0000X
NYF331541-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8159700Medicaid
S94824Medicare UPIN
NJ8159700Medicaid
NJ034003Medicare ID - Type Unspecified