Individual
MICHELLE L GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
110 MAIN AVE, PASSAIC, NJ 07055-4427
(973) 777-7638
(973) 777-9311
Mailing address
110 MAIN AVE, PASSAIC, NJ 07055-4427
(973) 777-7638
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
26NJ00908800
NJ
Other
Enumeration date
03/08/2019
Last updated
01/13/2023
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