Healthcare Provider Details

I. General information

NPI: 1336148287
Provider Name (Legal Business Name): KATHLEEN GAVIN RN, APN,C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN GAVIN RN, APN,C

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MILLENNIUM WAY LIFE CELL
BRANCHBURG NJ
08876-3876
US

IV. Provider business mailing address

37 WALLACE BLVD
HILLSBOROUGH NJ
08844-3438
US

V. Phone/Fax

Practice location:
  • Phone: 908-202-6523
  • Fax:
Mailing address:
  • Phone: 908-202-6523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number26NO04367100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number26NN04367100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: