Provider Demographics
NPI:1144227554
Name:GRANT, PAULA (NP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PARKWAY
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6278
Mailing Address - Country:US
Mailing Address - Phone:978-521-3230
Mailing Address - Fax:978-521-3256
Practice Address - Street 1:1 PARKWAY
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6278
Practice Address - Country:US
Practice Address - Phone:978-521-3230
Practice Address - Fax:978-521-3256
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA124651363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP2636OtherBLUE CROSS BLUE SHIELD
MANP2636OtherBLUE CROSS BLUE SHIELD
MANP2636Medicare ID - Type Unspecified