Basic Information
| Provider Information | |||||||||
| NPI: | 1346203403 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STICKEL | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | |||||||||
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| Credential: | NURSE PRACTITIONER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27 CHERRYWOOD DR | ||||||||
| Address2: | |||||||||
| City: | PISCATAWAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088546530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9086470180 | ||||||||
| FaxNumber: | 9086045218 | ||||||||
| Practice Location | |||||||||
| Address1: | 27 CHERRYWOOD DR | ||||||||
| Address2: | |||||||||
| City: | PISCATAWAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088546530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9086470180 | ||||||||
| FaxNumber: | 9086045218 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 26NN05761100 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.