Individual
GENESIS GRULLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, NP
Contact information
Practice address
803 W 180TH ST, APT 5, NEW YORK, NY 10033-3543
(917) 405-5490
Mailing address
803 W 180TH ST, APT 5, NEW YORK, NY 10033-3543
(917) 405-5490
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
672663
NY
363LF0000X
Family Nurse Practitioner
Primary
340240
NY
Other
Enumeration date
03/24/2015
Last updated
02/16/2016
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