Individual
NICOLE LOREN GROSSBARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
63 GRAND AVE STE 137, RIVER EDGE, NJ 07661-1930
(201) 696-2646
(201) 485-6570
Mailing address
41 BROWNSTONE WAY APT 209, ENGLEWOOD, NJ 07631-1211
(845) 558-7229
Taxonomy
Speciality
Code
Description
License number
State
163WN0002X
Neonatal Intensive Care Registered Nurse
717409
NY
363L00000X
Nurse Practitioner
Primary
26NR22658200
NJ
Other
Enumeration date
12/09/2020
Last updated
07/19/2021
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