Provider Demographics
NPI:1538820618
Name:PETECCA, NELA RIBEIRO (APN)
Entity type:Individual
Prefix:MRS
First Name:NELA
Middle Name:RIBEIRO
Last Name:PETECCA
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 1:400 ROUTE 10 W
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-2104
Mailing Address - Country:US
Mailing Address - Phone:973-891-1321
Mailing Address - Fax:973-206-5049
Practice Address - Street 1:400 ROUTE 10 W
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2104
Practice Address - Country:US
Practice Address - Phone:973-891-1321
Practice Address - Fax:973-206-5049
Is Sole Proprietor?:No
Enumeration Date:2022-01-01
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26-NJ01249200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26-NJ01249200OtherAPN LICENSE