Basic Information
| Provider Information | |||||||||
| NPI: | 1831502806 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACEY-STEWART | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | VANESSA | ||||||||
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| Credential: | MSN, APN-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 33 OVERLOOK RD | ||||||||
| Address2: | SUITE 311 | ||||||||
| City: | SUMMIT | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079013570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9085981500 | ||||||||
| FaxNumber: | 9085980197 | ||||||||
| Practice Location | |||||||||
| Address1: | 33 OVERLOOK RD | ||||||||
| Address2: | SUITE 311 | ||||||||
| City: | SUMMIT | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079013570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9085981500 | ||||||||
| FaxNumber: | 9085980197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2014 | ||||||||
| LastUpdateDate: | 09/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 26NR00493100 | NJ | N | Agencies | Hospice Care, Community Based | 363LA2200X | 204825 | LA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 367500000X | 26NR00493100 | NJ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 363LA2200X | 26NJ00493100 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | CAQH | 01 | 12746371 | OTHER |