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General NPI Number Information
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NPI Number | 1467631747
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Entity Type | Individual
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Provider Name | MARK M GRENIER RN
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Gender | Male
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Dates
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Enumeration Date | 11/02/2007
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Last Update Date | 11/02/2007
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Provider Practice Location Address
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Address Line | 2010 CEMETERY RD
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City | FABIUS
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State | NY
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Zip | 13063-9714
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Country | US
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Telephone | 315-638-9844
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Fax | 315-683-9844
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Provider Business Mailing Address
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Address Line | 2010 CEMETERY RD
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City | FABIUS
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State | NY
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Zip | 13063-9714
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Country | US
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Telephone | 315-638-9844
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Fax | 315-683-9844
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 594297
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163WN0800X
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Taxonomy Name | Neuroscience Registered Nurse
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License Number | 594297
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License Number State | NY
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