Healthcare Provider Details

I. General information

NPI: 1851953749
Provider Name (Legal Business Name): SHANE MICHELLE BARTHOLOMEW CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANE MICHELLE BARTHOLOMEW RN

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 ROSEBERRY ST
PHILLIPSBURG NJ
08865-1627
US

IV. Provider business mailing address

77 S COMMERCE WAY
BETHLEHEM PA
18017-8891
US

V. Phone/Fax

Practice location:
  • Phone: 908-847-4025
  • Fax: 833-514-6843
Mailing address:
  • Phone: 484-526-3830
  • Fax: 833-213-6428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP020199
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ00915000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: