Healthcare Provider Details

I. General information

NPI: 1659174415
Provider Name (Legal Business Name): TRACEE ANN ESCHENBRENNER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 HOPE RD
EATONTOWN NJ
07724-1277
US

IV. Provider business mailing address

18 PINEVIEW AVE
KEANSBURG NJ
07734-1257
US

V. Phone/Fax

Practice location:
  • Phone: 732-389-0697
  • Fax:
Mailing address:
  • Phone: 732-284-6198
  • Fax: 732-389-0611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number20NP03896700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: