Provider Demographics
NPI:1508491598
Name:KHADER, CAROLINE ROSE (CNM/WHNP)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ROSE
Last Name:KHADER
Suffix:
Gender:F
Credentials:CNM/WHNP
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:ROSE
Other - Last Name:LUCIANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM/WHNP
Mailing Address - Street 1:46 PRINCE ST STE 207
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:46 PRINCE ST.
Practice Address - Street 2:SUITE #207
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519
Practice Address - Country:US
Practice Address - Phone:203-787-2264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8768363LW0102X
CT467176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health