Provider Demographics
NPI:1588131551
Name:WARES, NICOLE (APN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:WARES
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 1:375 MOUNT PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2750
Mailing Address - Country:US
Mailing Address - Phone:973-731-9442
Mailing Address - Fax:973-587-8153
Practice Address - Street 1:5 FRANKLIN AVE STE 202
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3521
Practice Address - Country:US
Practice Address - Phone:973-429-8333
Practice Address - Fax:973-450-8157
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00844000363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care