MEDICARE: MS. EMILY ADELINE GRATTAN DNP, FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	078283-23	NH
2	390200000X	Student in an Organized Health Care Education/Training Program	078283-21	NH
3	363LP2300X	Primary Care Nurse Practitioner	354681	NY

General Provider Information

NPI Number	:	1558991000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EMILY ADELINE GRATTAN DNP, FNP

Provider Business Mailing Address
First Line	:	750 UNION ST
Second Line	:
City	:	HUDSON
State	:	NY
Zip	:	12534-3002
Country	:	US
Telephone Number	:	844-400-1975
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 UNION ST
Second Line	:
City	:	HUDSON
State	:	NY
Zip	:	12534-3002
Country	:	US
Telephone Number	:	844-400-1975
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2020
Last Update Date	:	01/27/2025

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