Healthcare Provider Details

I. General information

NPI: 1194361014
Provider Name (Legal Business Name): JESSICA MARIE GRZEBIEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2019
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 PARK ST
ATTLEBORO MA
02703-3137
US

IV. Provider business mailing address

15 COLUMBIA DR
CUMBERLAND RI
02864-6606
US

V. Phone/Fax

Practice location:
  • Phone: 508-222-5200
  • Fax:
Mailing address:
  • Phone: 401-523-1911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number127750
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: