Individual
KATRINA JALIAH THELISME
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2130 MILLBURN AVE, MAPLEWOOD, NJ 07040-3725
(973) 843-7149
Mailing address
2130 MILLBURN AVE STE C7, MAPLEWOOD, NJ 07040-3747
(908) 884-8419
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
26NJ15230700
NJ
Other
Enumeration date
07/29/2024
Last updated
03/04/2025
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