Individual
MISS TRICIA S GRAVESANDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
133 ELM ST, ORANGE, NJ 07050-4001
(862) 224-0940
Mailing address
133 ELM ST, ORANGE, NJ 07050-4001
(186) 224-0940
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
26NJ00959600
NJ
Other
Enumeration date
01/17/2020
Last updated
01/17/2020
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