Healthcare Provider Details

I. General information

NPI: 1396201380
Provider Name (Legal Business Name): HEATHER M GRENON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HILLSIDE FAMILY MEDICINE 14 MAPLE STREET SUITE 210
GILFORD NH
03249-6578
US

IV. Provider business mailing address

PO BOX 1327
LACONIA NH
03247-1327
US

V. Phone/Fax

Practice location:
  • Phone: 603-527-7114
  • Fax: 603-527-2945
Mailing address:
  • Phone: 603-524-3211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number062161-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: