Provider Demographics
NPI:1396201380
Name:GRENON, HEATHER M (FNP-BC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:GRENON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1327
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03247-1327
Mailing Address - Country:US
Mailing Address - Phone:603-524-3211
Mailing Address - Fax:
Practice Address - Street 1:HILLSIDE FAMILY MEDICINE
Practice Address - Street 2:14 MAPLE STREET SUITE 210
Practice Address - City:GILFORD
Practice Address - State:NH
Practice Address - Zip Code:03249-6578
Practice Address - Country:US
Practice Address - Phone:603-527-7114
Practice Address - Fax:603-527-2945
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH062161-23363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH062161-23OtherAPRN