Individual
MRS. SANDRA DENISE THEBAUD-YOUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-BC
Contact information
Practice address
254 EASTON AVENUE, NEW BRUNSWICK, NEW BRUNSWICK, NJ 08901
(908) 392-1948
(973) 337-2045
Mailing address
239 40TH ST, IRVINGTON, IRVINGTON, NJ 07111-1100
(973) 371-5563
(973) 337-2045
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
26NJ00129300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0147320
—
NJ
01
—
112818VGD
MEDICARE
—
Enumeration date
03/22/2007
Last updated
10/26/2009
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