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General NPI Number Information
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NPI Number | 1780174086
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Entity Type | Individual
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Provider Name | JONATHAN E. GERBODE-GRANT
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Gender | Male
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Dates
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Enumeration Date | 05/14/2018
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Last Update Date | 02/19/2026
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Provider Practice Location Address
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Address Line | 830 BOYLSTON ST STE 205
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City | CHESTNUT HILL
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State | MA
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Zip | 02467-2502
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Country | US
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Telephone | 617-732-1318
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Fax | 617-734-5763
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Provider Business Mailing Address
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Address Line | 830 BOYLSTON ST STE 205
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City | CHESTNUT HILL
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State | MA
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Zip | 02467-2502
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Country | US
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Telephone | 617-732-1318
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Fax | 617-734-5763
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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 | RN2312745
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License Number State | MA
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