Provider Demographics
NPI:1053367037
Name:FEDELE, HELENE E (ACNP)
Entity type:Individual
Prefix:
First Name:HELENE
Middle Name:E
Last Name:FEDELE
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 E GIBBSBORO RD
Mailing Address - Street 2:
Mailing Address - City:LINDENWOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-1907
Mailing Address - Country:US
Mailing Address - Phone:609-437-2020
Mailing Address - Fax:609-345-4290
Practice Address - Street 1:2922 ATLANTIC AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-6337
Practice Address - Country:US
Practice Address - Phone:609-437-2020
Practice Address - Fax:609-345-4290
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN06491300363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL309111200Medicaid
NJFE036779Medicare ID - Type Unspecified
NJ036779CN9Medicare PIN
FLAK597ZMedicare PIN
FL309111200Medicaid