Provider Demographics
NPI:1336848274
Name:MACHEL, JOANNA
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:MACHEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-1318
Mailing Address - Country:US
Mailing Address - Phone:973-634-5364
Mailing Address - Fax:
Practice Address - Street 1:1025 MAXWELL LN
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-6823
Practice Address - Country:US
Practice Address - Phone:800-867-8015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR17733700163WX0002X
NJ26NJ14946200363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk