Provider Demographics
NPI:1306054978
Name:SUDOL, NANCY E (ANPC)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:E
Last Name:SUDOL
Suffix:
Gender:F
Credentials:ANPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 PINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-6012
Mailing Address - Country:US
Mailing Address - Phone:609-748-2760
Mailing Address - Fax:
Practice Address - Street 1:408 E JIMMIE LEEDS RD
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9706
Practice Address - Country:US
Practice Address - Phone:609-652-6947
Practice Address - Fax:609-748-9075
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ006227Medicare ID - Type Unspecified