Healthcare Provider Details

I. General information

NPI: 1609113521
Provider Name (Legal Business Name): KATHRYN M VACCARO RN MSN MA APN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 US HIGHWAY 202 A150 HEALTH SERVICES
RARITAN NJ
08869-1424
US

IV. Provider business mailing address

710 LIVINGSTON RD
ELIZABETH NJ
07208-1308
US

V. Phone/Fax

Practice location:
  • Phone: 908-218-8070
  • Fax:
Mailing address:
  • Phone: 908-447-3256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00408100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: