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General NPI Number Information
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NPI Number | 1548311434
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Entity Type | Individual
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Provider Name | GEORGETTE WILSON-GRANBY
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Gender | Female
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 111 CENTRAL AVE SMMC, EMPLOYEE HEALTH - MSH ROOM 203
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City | NEWARK
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State | NJ
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Zip | 07102-1909
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Country | US
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Telephone | 973-877-5452
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Fax | 973-877-5454
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Provider Business Mailing Address
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Address Line | 3204 HANA RD
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City | EDISON
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State | NJ
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Zip | 08817-2552
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Country | US
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Telephone | 972-877-5452
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Fax | 973-877-5454
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 302415
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NN07778700
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License Number State | NJ
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