Healthcare Provider Details

I. General information

NPI: 1548489289
Provider Name (Legal Business Name): CAROLYN HAVENS NIEMANN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1382 LANES MILL RD STE 201
LAKEWOOD NJ
08701-3894
US

IV. Provider business mailing address

1973 SPRINGFIELD AVE
MAPLEWOOD NJ
07040-3435
US

V. Phone/Fax

Practice location:
  • Phone: 732-994-4242
  • Fax: 732-363-5164
Mailing address:
  • Phone: 973-996-2600
  • Fax: 973-996-2601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number25ME00044200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number25ME00044201
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: