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General NPI Number Information
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NPI Number | 1366170219
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Entity Type | Individual
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Provider Name | GRACE HALLENBECK DNP-FNP
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Gender | Female
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Dates
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Enumeration Date | 08/09/2022
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 7237 US-7
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City | POWNAL
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State | VT
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Zip | 05261
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Country | US
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Telephone | 802-681-2780
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Fax |
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Provider Business Mailing Address
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Address Line | 133 ADAMS RD
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City | WILLIAMSTOWN
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State | MA
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Zip | 01267-2930
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Country | US
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Telephone | 603-566-2742
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 101.0135597
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License Number State | VT
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