Provider Demographics
NPI:1396300265
Name:JEAN, MANOUCHKA (DNP, APN, CPNP)
Entity type:Individual
Prefix:
First Name:MANOUCHKA
Middle Name:
Last Name:JEAN
Suffix:
Gender:F
Credentials:DNP, APN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-2830
Mailing Address - Country:US
Mailing Address - Phone:908-553-8787
Mailing Address - Fax:
Practice Address - Street 1:190 S HARRISON ST
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1502
Practice Address - Country:US
Practice Address - Phone:973-674-8373
Practice Address - Fax:973-552-2805
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00908300363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics