Individual
GEORGETTE WILSON-GRANBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
111 CENTRAL AVE, SMMC, EMPLOYEE HEALTH - MSH ROOM 203, NEWARK, NJ 07102-1909
(973) 877-5452
(973) 877-5454
Mailing address
3204 HANA RD, EDISON, NJ 08817-2552
(972) 877-5452
(973) 877-5454
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
26NN07778700
NJ
363LA2200X
Adult Health Nurse Practitioner
302415
NY
Other
Enumeration date
01/16/2007
Last updated
07/08/2007
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