Healthcare Provider Details

I. General information

NPI: 1790767838
Provider Name (Legal Business Name): NANCY GRANGER CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WRIGHT ST
PALMER MA
01069-1138
US

IV. Provider business mailing address

25 BRETON ST
PALMER MA
01069-9302
US

V. Phone/Fax

Practice location:
  • Phone: 413-297-1791
  • Fax:
Mailing address:
  • Phone: 413-297-1791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number148763
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: