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General NPI Number Information
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NPI Number | 1093238040
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Entity Type | Individual
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Provider Name | CAROLINE M WICHMAN NP
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Gender | Female
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Dates
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Enumeration Date | 07/21/2017
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Last Update Date | 02/09/2022
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Provider Practice Location Address
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Address Line | 1000 RIVER RD STE 2-03
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City | TEANECK
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State | NJ
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Zip | 07666-1938
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Country | US
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Telephone | 201-692-2437
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Fax | 201-692-2214
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Provider Business Mailing Address
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Address Line | 1000 RIVER RD STE 2-03
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City | TEANECK
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State | NJ
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Zip | 07666-1938
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Country | US
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Telephone | 201-692-2437
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Fax | 201-692-2214
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024175118
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ01214900
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License Number State | NJ
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