Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 26NJ00888400 | NJ |
NPI | 1265999759 |
---|---|
Provider Name | Kelly Jo Gramm |
First Address | Williamstown, NJ 08094-9120 |
Second Address | Williamstown, NJ 08094-9120 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2019 |
Last Update Date | 22/12/2021 |