Healthcare Provider Details

I. General information

NPI: 1699265405
Provider Name (Legal Business Name): CAROLYN ROSE ST HILAIRE WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 MULBERRY ST
NEWARK NJ
07102-3528
US

IV. Provider business mailing address

21 LOMBARDY PL
MAPLEWOOD NJ
07040-3218
US

V. Phone/Fax

Practice location:
  • Phone: 973-622-3900
  • Fax:
Mailing address:
  • Phone: 973-415-7680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number26NR18242300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: