Healthcare Provider Details

I. General information

NPI: 1689899734
Provider Name (Legal Business Name): NICOLE L GRENIER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BALD HILL RD
WARWICK RI
02886-1617
US

IV. Provider business mailing address

15 LA SALLE SQ
PROVIDENCE RI
02903-1814
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-7959
  • Fax: 401-738-3857
Mailing address:
  • Phone: 401-444-6779
  • Fax: 401-444-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD13784
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: