Provider Demographics
NPI:1700131943
Name:DIVINE, KASEY C (CNM)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:C
Last Name:DIVINE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:NJ
Mailing Address - Zip Code:07823-1832
Mailing Address - Country:US
Mailing Address - Phone:201-230-4464
Mailing Address - Fax:
Practice Address - Street 1:408 MAIN ST STE 401A
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1732
Practice Address - Country:US
Practice Address - Phone:201-230-4464
Practice Address - Fax:866-715-8797
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MW00001700176B00000X
NJ25ME00075701176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife