Healthcare Provider Details

I. General information

NPI: 1447734488
Provider Name (Legal Business Name): ANGELA NICOLE KAISER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA LOMBARDI

II. Dates (important events)

Enumeration Date: 09/15/2018
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CLEMENTS BRIDGE RD
BARRINGTON NJ
08007-1814
US

IV. Provider business mailing address

600 CLEMENTS BRIDGE RD
BARRINGTON NJ
08007-1814
US

V. Phone/Fax

Practice location:
  • Phone: 565-478-0008
  • Fax: 856-547-1008
Mailing address:
  • Phone: 565-478-0008
  • Fax: 856-547-1008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number450410
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number645354
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number023648
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP019289
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: