Provider Demographics
NPI:1992468094
Name:ANTOINE, SHIRLEY (RN)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:ANTOINE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 HUGHES ST FL 2
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3303
Mailing Address - Country:US
Mailing Address - Phone:973-342-5231
Mailing Address - Fax:
Practice Address - Street 1:132 EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2491
Practice Address - Country:US
Practice Address - Phone:732-452-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-16
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR13519500163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse