Healthcare Provider Details

I. General information

NPI: 1821028432
Provider Name (Legal Business Name): JESSICA HAINES APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 STIRLING RD SUITE 201
WARREN NJ
07059-5778
US

IV. Provider business mailing address

76 STIRLING RD SUITE 201
WARREN NJ
07059-5778
US

V. Phone/Fax

Practice location:
  • Phone: 908-755-3457
  • Fax: 908-755-6905
Mailing address:
  • Phone: 908-755-3457
  • Fax: 908-755-6905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00318600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: