Healthcare Provider Details

I. General information

NPI: 1346632452
Provider Name (Legal Business Name): PAULA HASENAUER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2015
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 ROUTE 73 N STE 100
MARLTON NJ
08053-3422
US

IV. Provider business mailing address

75 WEST RED BANK AVE
WOODBURY NJ
08096-1694
US

V. Phone/Fax

Practice location:
  • Phone: 833-494-6724
  • Fax:
Mailing address:
  • Phone: 856-853-2168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00542600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00542600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: