Provider Demographics
NPI:1831870492
Name:PEDULLA, RACHEL LYNN (FNP-BC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNN
Last Name:PEDULLA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:NAVATTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2073 KLOCKNER RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3414
Mailing Address - Country:US
Mailing Address - Phone:609-584-1212
Mailing Address - Fax:609-584-0103
Practice Address - Street 1:2073 KLOCKNER RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3414
Practice Address - Country:US
Practice Address - Phone:609-584-1212
Practice Address - Fax:609-584-0103
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14848000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner