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General NPI Number Information
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NPI Number | 1477079861
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Entity Type | Individual
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Provider Name | CARISSA NICHOLE DEPEW DNP, AGPCNP
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Gender | Female
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Dates
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Enumeration Date | 08/17/2017
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 530 NEW BRUNSWICK AVE
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City | PERTH AMBOY
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State | NJ
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Zip | 08861-3654
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Country | US
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Telephone | 732-442-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 331 NEWMAN SPRINGS RD
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City | RED BANK
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State | NJ
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Zip | 07701-5688
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Country | US
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Telephone |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 23054
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 23054
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26NJ15094400
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License Number State | NJ
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