Provider Demographics
NPI:1215633219
Name:NOLASCO, MICHELLE MARIA
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIA
Last Name:NOLASCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 PIKEVIEW LN
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-1005
Mailing Address - Country:US
Mailing Address - Phone:908-759-9475
Mailing Address - Fax:
Practice Address - Street 1:140 PIKEVIEW LN
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-1005
Practice Address - Country:US
Practice Address - Phone:908-759-9475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant