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General NPI Number Information
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NPI Number | 1730719782
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Entity Type | Individual
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Provider Name | TRICIA S GRAVESANDE NP
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Gender | Female
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Dates
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Enumeration Date | 01/17/2020
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Last Update Date | 01/17/2020
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Provider Practice Location Address
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Address Line | 133 ELM ST
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City | ORANGE
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State | NJ
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Zip | 07050-4001
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Country | US
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Telephone | 862-224-0940
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Fax |
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Provider Business Mailing Address
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Address Line | 133 ELM ST
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City | ORANGE
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State | NJ
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Zip | 07050-4001
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Country | US
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Telephone | 186-224-0940
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 26NJ00959600
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License Number State | NJ
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