Provider Demographics
NPI:1043805146
Name:SCHOTTLAND, KIMBERLY ANNE (MSN, AGACNP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY ANNE
Middle Name:
Last Name:SCHOTTLAND
Suffix:
Gender:F
Credentials:MSN, AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 DEMAREST AVE
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-2413
Mailing Address - Country:US
Mailing Address - Phone:201-936-7201
Mailing Address - Fax:
Practice Address - Street 1:360 ESSEX ST STE 301
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-8566
Practice Address - Country:US
Practice Address - Phone:201-646-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ431795363LA2100X
NY431795363LA2100X
NJ26NJ01106400363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care