Healthcare Provider Details

I. General information

NPI: 1902525538
Provider Name (Legal Business Name): KAITLIN RENEE HULBERT APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 07/05/2025
Certification Date: 07/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 OLD SHORT HILLS RD STE 105
WEST ORANGE NJ
07052-1080
US

IV. Provider business mailing address

401 ROUTE 73 N STE 320
MARLTON NJ
08053-3426
US

V. Phone/Fax

Practice location:
  • Phone: 973-325-1115
  • Fax: 973-325-1186
Mailing address:
  • Phone: 973-325-1115
  • Fax: 973-325-1186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01357800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NJ01357800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: