Healthcare Provider Details

I. General information

NPI: 1750178141
Provider Name (Legal Business Name): NOLEDWEED-GUETHY J JEAN-BAPTISTE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 S LONG AVE
HILLSIDE NJ
07205-2719
US

IV. Provider business mailing address

1131 S LONG AVE
HILLSIDE NJ
07205-2719
US

V. Phone/Fax

Practice location:
  • Phone: 561-884-1575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15370100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: