Healthcare Provider Details

I. General information

NPI: 1407864655
Provider Name (Legal Business Name): CARMEN D LOU N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 KNOLLCROFT RD
LYONS NJ
07939-5001
US

IV. Provider business mailing address

1001 FABLE AVE
MANVILLE NJ
08835-2519
US

V. Phone/Fax

Practice location:
  • Phone: 908-647-0180
  • Fax: 908-604-5318
Mailing address:
  • Phone: 908-647-0180
  • Fax: 908-604-5318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NN05267500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: