Provider Demographics
NPI:1912931478
Name:PARADIS, NANCY (APRN-BC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:PARADIS
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 SAINT PAULS AVE APT 17P
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3746
Mailing Address - Country:US
Mailing Address - Phone:973-926-3518
Mailing Address - Fax:
Practice Address - Street 1:201 LYONS AVE AT OSBORNE TERRACE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112
Practice Address - Country:US
Practice Address - Phone:973-926-3518
Practice Address - Fax:973-926-9568
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN10440200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0079111Medicaid
NJP19615Medicare UPIN
NJ043906NXTMedicare ID - Type Unspecified