Provider Demographics
NPI:1407193881
Name:RIBOUL, BIANCA NAHOMI (APN)
Entity type:Individual
Prefix:MISS
First Name:BIANCA
Middle Name:NAHOMI
Last Name:RIBOUL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 ROUTE 70 E BLDG A
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2341
Mailing Address - Country:US
Mailing Address - Phone:856-797-4771
Mailing Address - Fax:859-797-4785
Practice Address - Street 1:765 ROUTE 70 E BLDG A
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2341
Practice Address - Country:US
Practice Address - Phone:856-797-4771
Practice Address - Fax:859-797-4785
Is Sole Proprietor?:No
Enumeration Date:2013-01-06
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15177600363LP0808X
NY312292-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse