Provider Demographics
NPI:1922880897
Name:NOWOSIELECKI, DARIA (APN)
Entity type:Individual
Prefix:
First Name:DARIA
Middle Name:
Last Name:NOWOSIELECKI
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 1:5 RAVEN RD
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-2545
Mailing Address - Country:US
Mailing Address - Phone:201-835-8526
Mailing Address - Fax:
Practice Address - Street 1:290 MADISON AVE STE 3A
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7401
Practice Address - Country:US
Practice Address - Phone:973-590-2448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14929100363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care