Provider Demographics
NPI:1780275917
Name:OLOO, NIXON (APN-BC)
Entity type:Individual
Prefix:
First Name:NIXON
Middle Name:
Last Name:OLOO
Suffix:
Gender:M
Credentials:APN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 AMBOY AVE STE 304-F5
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2552
Mailing Address - Country:US
Mailing Address - Phone:929-481-5451
Mailing Address - Fax:929-512-5519
Practice Address - Street 1:1199 AMBOY AVE STE 304-F5
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2552
Practice Address - Country:US
Practice Address - Phone:929-481-5451
Practice Address - Fax:929-512-5519
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-30
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01097300363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health