Provider Demographics
NPI:1164911384
Name:GERMAIN, PRIMEROSE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:PRIMEROSE
Middle Name:
Last Name:GERMAIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-4705
Mailing Address - Country:US
Mailing Address - Phone:908-398-1170
Mailing Address - Fax:
Practice Address - Street 1:134 EVERGREEN PL STE 100
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2019
Practice Address - Country:US
Practice Address - Phone:973-667-2221
Practice Address - Fax:877-480-5458
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00721500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily