Healthcare Provider Details

I. General information

NPI: 1609682590
Provider Name (Legal Business Name): KRISTEN LEIGH MONAGHAN APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTEN LEIGH WAGNER APRN, FNP-C

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4361 ROUTE 42
TURNERSVILLE NJ
08012-1794
US

IV. Provider business mailing address

106 REDWOOD ST
SICKLERVILLE NJ
08081-9412
US

V. Phone/Fax

Practice location:
  • Phone: 568-854-5798
  • Fax: 856-885-4582
Mailing address:
  • Phone: 856-408-4493
  • Fax: 856-885-4582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15199500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: