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General NPI Number Information
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NPI Number | 1386740538
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Entity Type | Organization
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Legal Business Name | BOSTONVA HEALTH CARE SYSTEM
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | 940 BELMONT ST 11PC
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City | BROCKTON
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State | MA
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Zip | 02301-5596
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Country | US
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Telephone | 508-583-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 940 BELMONT ST 11PC
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City | BROCKTON
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State | MA
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Zip | 02301-5596
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MARCIA ELLEN GRABER
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Credential | RNP
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Telephone | 508-583-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 143788
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License Number State | MA
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