Healthcare Provider Details

I. General information

NPI: 1003584277
Provider Name (Legal Business Name): LAUREN GRANT ZWICK NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE
BOSTON MA
02215-5491
US

IV. Provider business mailing address

18 ISLAND HILL AVE UNIT 107
MELROSE MA
02176-6143
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-4042
  • Fax:
Mailing address:
  • Phone: 860-930-2918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2289822
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberRN2289822
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberRN2289822
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: