Provider Demographics
NPI:1447383054
Name:CLANCY, GRACE T (PNP)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:T
Last Name:CLANCY
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 HAVERHILL ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-1550
Mailing Address - Country:US
Mailing Address - Phone:978-475-4522
Mailing Address - Fax:978-475-6531
Practice Address - Street 1:140 HAVERHILL ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-1550
Practice Address - Country:US
Practice Address - Phone:978-475-4522
Practice Address - Fax:978-475-6531
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA138686363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics