Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 26NJ00629800 | NJ |
NPI | 1003262064 |
---|---|
Provider Name | Mrs. Lauren Anne Carucci |
First Address | River Vale, NJ 07675-5630 |
Second Address | Hackensack, NJ 07601-1915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2016 |
Last Update Date | 09/05/2016 |