Provider Demographics
NPI:1396172797
Name:CARUSO, KELLY MARIE (ACNP)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:MARIE
Last Name:CARUSO
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 FERNWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016
Mailing Address - Country:US
Mailing Address - Phone:609-864-0353
Mailing Address - Fax:
Practice Address - Street 1:329 FERNWOOD AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-2508
Practice Address - Country:US
Practice Address - Phone:609-864-0353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00449700363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care