Basic Information
Provider Information
NPI: 1003154543
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ANDRUS
FirstName: NICOLE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DAOM, L.AC.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 88 RIDGE TER
Address2:  
City: NEPTUNE CITY
State: NJ
PostalCode: 077536614
CountryCode: US
TelephoneNumber: 6142181363
FaxNumber:  
Practice Location
Address1: 424 S MAIN ST
Address2:  
City: FORKED RIVER
State: NJ
PostalCode: 087314654
CountryCode: US
TelephoneNumber: 6099713500
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/17/2013
LastUpdateDate: 05/08/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171100000X25MZ00112000NJY Other Service ProvidersAcupuncturist 
171100000X65.000301OHN Other Service ProvidersAcupuncturist 
171100000X198.001041ILN Other Service ProvidersAcupuncturist 

No ID Information.


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