1245269588 NPI number — MS. PATRICIA M GRINDELL APRN-BC, ADM

Table of content: MS. PATRICIA M GRINDELL APRN-BC, ADM (NPI 1245269588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245269588 NPI number — MS. PATRICIA M GRINDELL APRN-BC, ADM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRINDELL
Provider First Name:
PATRICIA
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN-BC, ADM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245269588
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 MILL RD
Provider Second Line Business Mailing Address:
SUITE 180
Provider Business Mailing Address City Name:
FAIRHAVEN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02719-5252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-973-2000
Provider Business Mailing Address Fax Number:
508-973-2001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1030 PRESIDENT AVE
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
FALL RIVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02720-5923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-973-1750
Provider Business Practice Location Address Fax Number:
508-235-6658
Provider Enumeration Date:
06/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  RN141286 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0700703 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com