Provider Demographics
NPI:1740503259
Name:NARDELLA, PAULINE E (FNP, MS, MPA, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:PAULINE
Middle Name:E
Last Name:NARDELLA
Suffix:
Gender:F
Credentials:FNP, MS, MPA, IBCLC
Other - Prefix:
Other - First Name:PAULINE
Other - Middle Name:E
Other - Last Name:WHITE-NARDELLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC, MS, MPA, IBC
Mailing Address - Street 1:2 PVT LOVETT CT
Mailing Address - Street 2:
Mailing Address - City:BLAUVELT
Mailing Address - State:NY
Mailing Address - Zip Code:10913-1247
Mailing Address - Country:US
Mailing Address - Phone:845-323-1830
Mailing Address - Fax:
Practice Address - Street 1:2 PVT LOVETT CT
Practice Address - Street 2:
Practice Address - City:BLAUVELT
Practice Address - State:NY
Practice Address - Zip Code:10913-1247
Practice Address - Country:US
Practice Address - Phone:845-323-1830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341079363LF0000X
NJ26NR12756700163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse