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General NPI Number Information
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NPI Number | 1396172797
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Entity Type | Individual
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Provider Name | KELLY MARIE CARUSO ACNP
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Gender | Female
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Dates
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Enumeration Date | 09/30/2013
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 329 FERNWOOD AVE
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City | BURLINGTON
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State | NJ
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Zip | 08016-2508
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Country | US
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Telephone | 609-864-0353
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Fax |
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Provider Business Mailing Address
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Address Line | 329 FERNWOOD AVENUE
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City | BURLINGTON
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State | NJ
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Zip | 08016
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Country | US
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Telephone | 609-864-0353
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Fax |
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 26NJ00449700
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License Number State | NJ
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