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General NPI Number Information
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NPI Number | 1225131683
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Entity Type | Individual
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Provider Name | THERESA ANN LORD-STOUT APNC
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Gender | Female
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11 BISHOP PLACE RUTGERS UNIVERSITY HURTADO HEALTH CENTER
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901
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Country | US
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Telephone | 732-932-7402
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Fax |
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Provider Business Mailing Address
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Address Line | 316 SHARP STREET
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City | HACKETTSTOWN
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State | NJ
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Zip | 07840-1932
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Country | US
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Telephone | 908-852-4828
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Fax | 908-852-2056
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NN07286100
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License Number State | NJ
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