Provider Demographics
NPI:1326632118
Name:DE GRIJS, MAURA ELIZABETH-GRACE
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:ELIZABETH-GRACE
Last Name:DE GRIJS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5046 THOROUGHBRED LN
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4225
Mailing Address - Country:US
Mailing Address - Phone:615-370-8080
Mailing Address - Fax:
Practice Address - Street 1:5046 THOROUGHBRED LN
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4225
Practice Address - Country:US
Practice Address - Phone:615-370-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN30224363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program