Provider Demographics
NPI:1174816953
Name:GRANT, TERESA (RN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:RN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 REMBRANDT WAY
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-2990
Mailing Address - Country:US
Mailing Address - Phone:609-443-1005
Mailing Address - Fax:
Practice Address - Street 1:1150 SPRINGFIELD AVENUE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111
Practice Address - Country:US
Practice Address - Phone:973-399-6292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305381-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health