Healthcare Provider Details

I. General information

NPI: 1710676572
Provider Name (Legal Business Name): STEPHANIE KAYE RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 SALEM RD
TOWNSHIP OF WASHINGTON NJ
07676-4521
US

IV. Provider business mailing address

81 SALEM RD
TOWNSHIP OF WASHINGTON NJ
07676-4521
US

V. Phone/Fax

Practice location:
  • Phone: 201-745-3003
  • Fax:
Mailing address:
  • Phone: 201-745-3003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberXXXXXXXXX
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: