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General NPI Number Information
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NPI Number | 1063848885
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Entity Type | Individual
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Provider Name | GRACE AMISTOSO APN
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Gender | Female
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Dates
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Enumeration Date | 09/25/2013
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Last Update Date | 09/25/2013
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Provider Practice Location Address
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Address Line | LOCK BAG & WOODBRIGE AVE E JERSEY STATE PRISON ATTN MEDICAL DEPT
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City | WOODBRIDGE
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State | NJ
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Zip | 07067
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Country | US
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Telephone | 732-499-5010
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Fax |
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Provider Business Mailing Address
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Address Line | LOCKBAG R E JERSEY STATE PRISON ATTN MEDICAL DEPT
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City | RAHWAY
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State | NJ
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Zip | 07106
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Country | US
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Telephone | 732-399-5010
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26NC06249800
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License Number State | NJ
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