Provider Demographics
NPI:1336600063
Name:LALLY, CAROLINE (APN)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:LALLY
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 1:777 S WHITE HORSE PIKE STE E1
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-2029
Mailing Address - Country:US
Mailing Address - Phone:609-567-0608
Mailing Address - Fax:609-567-1295
Practice Address - Street 1:777 S WHITE HORSE PIKE STE E1
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-2029
Practice Address - Country:US
Practice Address - Phone:609-567-0608
Practice Address - Fax:609-567-1295
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR13749900163W00000X
NJ26NJ00952600363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse