Provider Demographics
NPI:1013498823
Name:VARGHESE, GRACE SHIBU (FNP-C)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:SHIBU
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 PRINCESS DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-4107
Mailing Address - Country:US
Mailing Address - Phone:973-572-6198
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY HOSPITAL
Practice Address - Street 2:
Practice Address - City:150,BERGEN STREET,NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103
Practice Address - Country:US
Practice Address - Phone:973-972-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00840200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily