Provider Demographics
NPI:1295461838
Name:LOUIS-JACQUES, CARMEL BETHSAIDA
Entity Type:Individual
Prefix:
First Name:CARMEL
Middle Name:BETHSAIDA
Last Name:LOUIS-JACQUES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 HIGHLAND AVE APT 6L
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-2391
Mailing Address - Country:US
Mailing Address - Phone:973-280-8908
Mailing Address - Fax:
Practice Address - Street 1:457 HIGHLAND AVE APT 6L
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-2391
Practice Address - Country:US
Practice Address - Phone:973-280-8908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01344000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily