Provider Demographics
NPI:1578641809
Name:CALDWELL, BARBARA (APN)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RUTGERS NURSING FACULTY PRACTICE
Mailing Address - Street 2:65 BERGEN STREET SSB 1127
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101
Mailing Address - Country:US
Mailing Address - Phone:973-732-6040
Mailing Address - Fax:862-902-7874
Practice Address - Street 1:449 BROAD STREET
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102
Practice Address - Country:US
Practice Address - Phone:973-732-6040
Practice Address - Fax:862-902-7874
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO05212200163W00000X
NJ26NC05212200363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
049921Medicare ID - Type Unspecified