Provider Demographics
NPI:1336849850
Name:ADVANI, NISHA
Entity Type:Individual
Prefix:MRS
First Name:NISHA
Middle Name:
Last Name:ADVANI
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:NISHA
Other - Middle Name:
Other - Last Name:LUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN, DNP
Mailing Address - Street 1:150 W 56TH ST APT 3205
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3833
Mailing Address - Country:US
Mailing Address - Phone:908-787-7749
Mailing Address - Fax:
Practice Address - Street 1:150 W 56TH ST APT 3205
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3833
Practice Address - Country:US
Practice Address - Phone:908-787-7749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01442600363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology