Healthcare Provider Details

I. General information

NPI: 1124367131
Provider Name (Legal Business Name): ASHLEY BROOKE BARANWAL A/GNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY BROOKE LOEHMER

II. Dates (important events)

Enumeration Date: 02/11/2013
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 BEAUVOIR AVE
SUMMIT NJ
07901-3533
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 908-522-5329
  • Fax: 908-598-5453
Mailing address:
  • Phone: 844-362-1735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ01400800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: