Provider Demographics
NPI:1477628816
Name:MENEWISCH, CATHERINE A (CRNP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:MENEWISCH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ROOSEVELT DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL SPRINGS
Mailing Address - State:NJ
Mailing Address - Zip Code:08021
Mailing Address - Country:US
Mailing Address - Phone:856-232-6058
Mailing Address - Fax:856-232-8260
Practice Address - Street 1:16 ROOSEVELT DRIVE
Practice Address - Street 2:
Practice Address - City:LAUREL SPRINGS
Practice Address - State:NJ
Practice Address - Zip Code:08021
Practice Address - Country:US
Practice Address - Phone:856-232-6058
Practice Address - Fax:856-232-8260
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN06143900363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8039208Medicaid
NJ031322Medicare ID - Type Unspecified
NJ8039208Medicaid