Individual
KELSEY LICATO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
1 DIAMOND HILL RD, BERKELEY HEIGHTS, NJ 07922-2104
(908) 273-4300
Mailing address
1 DIAMOND HILL RD, BERKELEY HEIGHTS, NJ 07922-2104
(908) 273-4300
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
26NJ01061700
NJ
363LP2300X
Primary Care Nurse Practitioner
26NJ01061700
NJ
Other
Enumeration date
11/19/2020
Last updated
11/19/2020
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