Healthcare Provider Details

I. General information

NPI: 1255691275
Provider Name (Legal Business Name): MEREDITH CARMICHAEL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 STURBRIDGE DR
ERIAL NJ
08081-9603
US

IV. Provider business mailing address

16 STURBRIDGE DR
ERIAL NJ
08081-9603
US

V. Phone/Fax

Practice location:
  • Phone: 856-912-8123
  • Fax:
Mailing address:
  • Phone: 856-912-8123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NJ00417200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: