Healthcare Provider Details

I. General information

NPI: 1053143255
Provider Name (Legal Business Name): SOLENE GEFFRARD GRAND-PIERRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BLENDALL ST
BROCKTON MA
02302-1739
US

IV. Provider business mailing address

10 BLENDALL ST
BROCKTON MA
02302-1739
US

V. Phone/Fax

Practice location:
  • Phone: 857-269-8311
  • Fax: 857-269-8311
Mailing address:
  • Phone: 857-269-8311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCNA-108743
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: