Provider Demographics
NPI:1588734008
Name:CARROLL-BASSETT, MARYBETH (APN)
Entity type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:CARROLL-BASSETT
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 1:2051 BRIGGS RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-4608
Mailing Address - Country:US
Mailing Address - Phone:856-234-3332
Mailing Address - Fax:856-581-2115
Practice Address - Street 1:2051 BRIGGS RD
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-4608
Practice Address - Country:US
Practice Address - Phone:856-234-3332
Practice Address - Fax:856-581-2115
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN10005700363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP29523Medicare UPIN