Provider Demographics
NPI:1225535420
Name:GRUNDY, KAREN J (RN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:J
Last Name:GRUNDY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:J
Other - Last Name:MCKEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:641 BAKER ST
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-2207
Mailing Address - Country:US
Mailing Address - Phone:781-223-4245
Mailing Address - Fax:
Practice Address - Street 1:780 ALBANY ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2755
Practice Address - Country:US
Practice Address - Phone:857-654-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2260512163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse