Provider Demographics
NPI:1699265405
Name:ST HILAIRE, CAROLYN ROSE (WHNP-BC)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ROSE
Last Name:ST HILAIRE
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 LOMBARDY PL
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3218
Mailing Address - Country:US
Mailing Address - Phone:973-415-7680
Mailing Address - Fax:
Practice Address - Street 1:240 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-3528
Practice Address - Country:US
Practice Address - Phone:973-622-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR18242300363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health