Healthcare Provider Details

I. General information

NPI: 1740890573
Provider Name (Legal Business Name): KRISTY MARIE GRAINGER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 HOSPITAL DR
WINCHENDON MA
01475-1820
US

IV. Provider business mailing address

55 HOSPITAL DR
WINCHENDON MA
01475-1899
US

V. Phone/Fax

Practice location:
  • Phone: 978-297-2311
  • Fax: 978-297-4173
Mailing address:
  • Phone: 978-297-2311
  • Fax: 978-297-4173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN270461
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: