Provider Demographics
NPI:1366832073
Name:NILSSON, GARBO YOUNG (NP)
Entity Type:Individual
Prefix:
First Name:GARBO
Middle Name:YOUNG
Last Name:NILSSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1865 ROUTE 70 EAST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2013
Mailing Address - Country:US
Mailing Address - Phone:856-427-4336
Mailing Address - Fax:856-429-0589
Practice Address - Street 1:1865 ROUTE 70 EAST
Practice Address - Street 2:SUITE 210
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2013
Practice Address - Country:US
Practice Address - Phone:856-427-4336
Practice Address - Fax:856-429-0589
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00548400363LF0000X
PASP014431363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily