MEDICARE: STACIE ANN CARR-DREHER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	26NJ01151800	NJ

General Provider Information

NPI Number	:	1609561026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACIE ANN CARR-DREHER

Provider Business Mailing Address
First Line	:	93 CUMBERLAND AVE
Second Line	:
City	:	VERONA
State	:	NJ
Zip	:	07044-2107
Country	:	US
Telephone Number	:	201-303-5912
Fax Number	:

Provider Business Practice Location Address
First Line	:	93 CUMBERLAND AVE
Second Line	:
City	:	VERONA
State	:	NJ
Zip	:	07044-2107
Country	:	US
Telephone Number	:	201-303-5912
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2023
Last Update Date	:	04/11/2023

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Directions to “ STACIE ANN CARR-DREHER ” Practice Location

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