Provider Demographics
NPI:1346473584
Name:FRAKTMAN, MARILYN GRIMES (RN, PH D)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:GRIMES
Last Name:FRAKTMAN
Suffix:
Gender:F
Credentials:RN, PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MARY ELLEN RD
Mailing Address - Street 2:
Mailing Address - City:WABAN
Mailing Address - State:MA
Mailing Address - Zip Code:02468-1026
Mailing Address - Country:US
Mailing Address - Phone:617-966-3338
Mailing Address - Fax:
Practice Address - Street 1:65 MARY ELLEN RD
Practice Address - Street 2:
Practice Address - City:WABAN
Practice Address - State:MA
Practice Address - Zip Code:02468-1026
Practice Address - Country:US
Practice Address - Phone:617-966-3338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76445163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health