Provider Demographics
NPI:1144947961
Name:EXANTUS, HUBERLINE (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:HUBERLINE
Middle Name:
Last Name:EXANTUS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 EASTERN PKWY
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-1753
Mailing Address - Country:US
Mailing Address - Phone:973-735-4796
Mailing Address - Fax:
Practice Address - Street 1:19 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2530
Practice Address - Country:US
Practice Address - Phone:973-735-4796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR19040900163W00000X
NJ26NJ01383500363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse