Basic Information
| Provider Information | |||||||||
| NPI: | 1225131683 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LORD-STOUT | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APNC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 316 SHARP STREET | ||||||||
| Address2: | |||||||||
| City: | HACKETTSTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078401932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9088524828 | ||||||||
| FaxNumber: | 9088522056 | ||||||||
| Practice Location | |||||||||
| Address1: | 11 BISHOP PLACE | ||||||||
| Address2: | RUTGERS UNIVERSITY HURTADO HEALTH CENTER | ||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7329327402 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 26NN07286100 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.