Provider Demographics
NPI:1609113521
Name:VACCARO, KATHRYN M (RN MSN MA APN-BC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:VACCARO
Suffix:
Gender:F
Credentials:RN MSN MA APN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 LIVINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1308
Mailing Address - Country:US
Mailing Address - Phone:908-447-3256
Mailing Address - Fax:
Practice Address - Street 1:1001 US HIGHWAY 202
Practice Address - Street 2:A150 HEALTH SERVICES
Practice Address - City:RARITAN
Practice Address - State:NJ
Practice Address - Zip Code:08869-1424
Practice Address - Country:US
Practice Address - Phone:908-218-8070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00408100363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health