Provider Demographics
NPI:1285936211
Name:GANIEL, JOLENE RENEE (NP-C)
Entity type:Individual
Prefix:MS
First Name:JOLENE
Middle Name:RENEE
Last Name:GANIEL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 ASBURY RD
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-7104
Mailing Address - Country:US
Mailing Address - Phone:609-703-9596
Mailing Address - Fax:
Practice Address - Street 1:6410 NEW JERSEY AVE
Practice Address - Street 2:
Practice Address - City:WILDWOOD CREST
Practice Address - State:NJ
Practice Address - Zip Code:08260-1216
Practice Address - Country:US
Practice Address - Phone:609-523-1331
Practice Address - Fax:609-522-1516
Is Sole Proprietor?:No
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00311700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily