Provider Demographics
NPI:1447519020
Name:CHANG, GRACE S (APN)
Entity type:Individual
Prefix:MS
First Name:GRACE
Middle Name:S
Last Name:CHANG
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 RT 206 NORTH
Mailing Address - Street 2:MINUTE CLINIC / CVS 6060
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930
Mailing Address - Country:US
Mailing Address - Phone:908-879-6818
Mailing Address - Fax:
Practice Address - Street 1:276 MAIN ST.
Practice Address - Street 2:MINUTE CLINIC / CVS #2416
Practice Address - City:DEMILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2646
Practice Address - Country:US
Practice Address - Phone:973-664-2391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00366900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily