Individual
JALICIA GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
15 WAYNE AVE, EAST ORANGE, NJ 07018-1907
(914) 490-5941
Mailing address
15 WAYNE AVE, EAST ORANGE, NJ 07018-1907
(914) 490-5941
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
26NR23060600
NJ
363LF0000X
Family Nurse Practitioner
Primary
26NJ14886900
NJ
Other
Enumeration date
12/22/2014
Last updated
09/29/2023
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