Healthcare Provider Details

I. General information

NPI: 1679540397
Provider Name (Legal Business Name): GRACE FIMBEL CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRACE FIMBEL

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PRINCESS RD STE C
LAWRENCEVILLE NJ
08648
US

IV. Provider business mailing address

2 PRINCESS RD STE C
LAWRENCEVILLE NJ
08648
US

V. Phone/Fax

Practice location:
  • Phone: 609-896-0777
  • Fax: 609-896-3266
Mailing address:
  • Phone: 609-896-0777
  • Fax: 609-896-3266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number25ME00038500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: