Provider Demographics
NPI:1548489289
Name:NIEMANN, CAROLYN HAVENS (CNM, MSN)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:HAVENS
Last Name:NIEMANN
Suffix:
Gender:F
Credentials:CNM, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1973 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3435
Mailing Address - Country:US
Mailing Address - Phone:973-996-2600
Mailing Address - Fax:973-996-2601
Practice Address - Street 1:1973 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3435
Practice Address - Country:US
Practice Address - Phone:973-996-2600
Practice Address - Fax:973-996-2601
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00044200176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0139394Medicaid