Provider Demographics
NPI:1558181842
Name:DONOGHUE, NICHOLETTE (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:NICHOLETTE
Middle Name:
Last Name:DONOGHUE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 EXETER ST
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-3049
Mailing Address - Country:US
Mailing Address - Phone:973-714-2934
Mailing Address - Fax:
Practice Address - Street 1:58 N SUSSEX ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-4259
Practice Address - Country:US
Practice Address - Phone:609-256-6380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-12
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15165000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health