MEDICARE: NANCY GRANGER CNS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	148763	MA

General Provider Information

NPI Number	:	1790767838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY GRANGER CNS

Provider Business Mailing Address
First Line	:	25 BRETON ST
Second Line	:
City	:	PALMER
State	:	MA
Zip	:	01069-9302
Country	:	US
Telephone Number	:	413-297-1791
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 WRIGHT ST
Second Line	:
City	:	PALMER
State	:	MA
Zip	:	01069-1138
Country	:	US
Telephone Number	:	413-297-1791
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	10/07/2014

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