Provider Demographics
NPI:1720245293
Name:NELSON, BARBARA J (NURSEPRACTITIONER NP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:NELSON
Suffix:
Gender:F
Credentials:NURSEPRACTITIONER NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042
Mailing Address - Country:US
Mailing Address - Phone:973-746-3535
Mailing Address - Fax:973-746-4385
Practice Address - Street 1:4 ROBERT RD
Practice Address - Street 2:
Practice Address - City:TOWACO
Practice Address - State:NJ
Practice Address - Zip Code:07082
Practice Address - Country:US
Practice Address - Phone:973-725-5416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNN106300363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health