Healthcare Provider Details

I. General information

NPI: 1043031420
Provider Name (Legal Business Name): DAWN GRIMALDI FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STAFFORD ST STE 154
SPRINGFIELD MA
01104-3583
US

IV. Provider business mailing address

8 LEAVIEW DR
WESTFIELD MA
01085-1828
US

V. Phone/Fax

Practice location:
  • Phone: 413-748-7095
  • Fax:
Mailing address:
  • Phone: 413-433-2768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN277350
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: