Provider Demographics
NPI:1265111975
Name:PAMPINELLA, LAUREN (APN)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:PAMPINELLA
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 1:215 HUNTER AVE
Mailing Address - Street 2:
Mailing Address - City:FANWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07023-1062
Mailing Address - Country:US
Mailing Address - Phone:718-825-4557
Mailing Address - Fax:
Practice Address - Street 1:765 ROUTE 10 E STE 201
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-1925
Practice Address - Country:US
Practice Address - Phone:973-989-0068
Practice Address - Fax:973-361-8955
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJAG03230078363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty