Provider Demographics
NPI:1306828512
Name:TRIVERS, GRACE S (APRN-BC)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:S
Last Name:TRIVERS
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 PRINCETON ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NORTH CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-1558
Mailing Address - Country:US
Mailing Address - Phone:978-256-6579
Mailing Address - Fax:978-256-1943
Practice Address - Street 1:73 PRINCETON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:NORTH CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-1558
Practice Address - Country:US
Practice Address - Phone:978-256-6579
Practice Address - Fax:978-256-1943
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA119209364SP0808X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA890000446OtherRAILROAD MEDICARE
MA758727OtherTUFTS
NH4007530Y0MA02OtherBCBSNH
MA043476807-08OtherPACIFICARE
MA162568OtherMHN
MA1851713Medicaid
MAPN0057OtherBCBSMA
MA1008984OtherCIGNA
MA0022320OtherNHP
MA4339587OtherAETNA
MA006475OtherTRICARE
MA1388318000OtherMAGELLAN
MA83-01340OtherEVERCARE
MA83-01340OtherEVERCARE
MA043476807-08OtherPACIFICARE
MA162568OtherMHN