Provider Demographics
NPI:1558109603
Name:PUGLIESE, KACEY (DNP, AGPCNP-BC, CNOR)
Entity type:Individual
Prefix:
First Name:KACEY
Middle Name:
Last Name:PUGLIESE
Suffix:
Gender:F
Credentials:DNP, AGPCNP-BC, CNOR
Other - Prefix:
Other - First Name:KACEY
Other - Middle Name:
Other - Last Name:CHAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19 LYNWOOD RD
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1714
Mailing Address - Country:US
Mailing Address - Phone:973-557-5641
Mailing Address - Fax:
Practice Address - Street 1:140 BERGEN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2425
Practice Address - Country:US
Practice Address - Phone:973-972-4977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR18275900163W00000X
NJ26NJ15070200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse