Individual
GRACE AFFUL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
750 N BROAD ST APT 12A, ELIZABETH, NJ 07208-2436
(988) 662-3454
Mailing address
750 N BROAD ST APT 12A, ELIZABETH, NJ 07208-2436
(988) 662-3454
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
552973-1
NY
Other
Enumeration date
04/09/2010
Last updated
04/09/2010
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