Provider Demographics
NPI:1710597422
Name:HUNTERTON-ANDERSON, JACQUELINE HAYDEE (DNP, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:HAYDEE
Last Name:HUNTERTON-ANDERSON
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 NEWTON SPARTA RD STE 2
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-2775
Mailing Address - Country:US
Mailing Address - Phone:973-903-7161
Mailing Address - Fax:
Practice Address - Street 1:280 NEWTON SPARTA RD STE 2
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2775
Practice Address - Country:US
Practice Address - Phone:973-903-7161
Practice Address - Fax:973-860-1152
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR18141000163WP0808X
NJ26NJ01046400363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health