Provider Demographics
NPI:1730611666
Name:MACALALAG, GRACE (MSN, APN-C, CCRN)
Entity type:Individual
Prefix:MISS
First Name:GRACE
Middle Name:
Last Name:MACALALAG
Suffix:
Gender:F
Credentials:MSN, APN-C, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 MORRIS AVE
Mailing Address - Street 2:FLOOR ONE
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-5503
Mailing Address - Country:US
Mailing Address - Phone:908-656-2497
Mailing Address - Fax:
Practice Address - Street 1:239 MORRIS AVE
Practice Address - Street 2:FLOOR ONE
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-5503
Practice Address - Country:US
Practice Address - Phone:908-656-2497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR10560900163WC0200X
NJ26NJ00718300363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine