Provider Demographics
NPI:1700923182
Name:FEDORCHAK, DEBRA (RN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:FEDORCHAK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 BUNN DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-2859
Mailing Address - Country:US
Mailing Address - Phone:609-683-7111
Mailing Address - Fax:609-921-3620
Practice Address - Street 1:256 BUNN DR
Practice Address - Street 2:SUITE 6
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-2859
Practice Address - Country:US
Practice Address - Phone:609-683-7111
Practice Address - Fax:609-921-3620
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP35317Medicare UPIN