Provider Demographics
NPI:1982338489
Name:NSIBIRWA, NANTALE (NP)
Entity Type:Individual
Prefix:
First Name:NANTALE
Middle Name:
Last Name:NSIBIRWA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1369 FARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-2832
Mailing Address - Country:US
Mailing Address - Phone:267-307-7786
Mailing Address - Fax:
Practice Address - Street 1:321 N WARREN ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-4741
Practice Address - Country:US
Practice Address - Phone:609-278-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR24108800163W00000X
NJ26NJ01375200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse