Provider Demographics
NPI:1588306377
Name:ARTWELL-NICHOLSON, CAMILLA THERESA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CAMILLA
Middle Name:THERESA
Last Name:ARTWELL-NICHOLSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 BADGER AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07108-3160
Mailing Address - Country:US
Mailing Address - Phone:908-267-2830
Mailing Address - Fax:
Practice Address - Street 1:197 BADGER AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07108-3160
Practice Address - Country:US
Practice Address - Phone:908-267-2830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01279000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner