Provider Demographics
NPI:1336148287
Name:GAVIN, KATHLEEN (RN, APN,C)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:GAVIN
Suffix:
Gender:F
Credentials:RN, APN,C
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:GAVIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, APN,C
Mailing Address - Street 1:37 WALLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-3438
Mailing Address - Country:US
Mailing Address - Phone:908-202-6523
Mailing Address - Fax:
Practice Address - Street 1:1 MILLENNIUM WAY
Practice Address - Street 2:LIFE CELL
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-3876
Practice Address - Country:US
Practice Address - Phone:908-202-6523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO04367100163WX0106X
NJ26NN04367100163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ018926Medicare ID - Type UnspecifiedPROVIDER ID NUMBER