Individual
KELLY VANWYCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
477 ROUTE 10 STE 205, RANDOLPH, NJ 07869-2144
(973) 560-9500
Mailing address
700 ROUTE 46 E STE 450, FAIRFIELD, NJ 07004-1583
(973) 559-3700
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
26NJ00792600
NJ
Other
Enumeration date
01/18/2018
Last updated
01/18/2018
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