Individual
GRACE AN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
111 E 210TH ST FL 2, BRONX, NY 10467
(718) 920-7303
(718) 652-6642
Mailing address
539 BLOOMFIELD AVE STE 1, NEWARK, NJ 07107-1385
(735) 669-9009
(735) 666-6929
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F341274
NY
Other
Enumeration date
06/19/2017
Last updated
06/19/2018
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