Provider Demographics
NPI:1467631747
Name:GRENIER, MARK M (RN)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:M
Last Name:GRENIER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2010 CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:FABIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13063-9714
Mailing Address - Country:US
Mailing Address - Phone:315-638-9844
Mailing Address - Fax:315-683-9844
Practice Address - Street 1:2010 CEMETERY RD
Practice Address - Street 2:
Practice Address - City:FABIUS
Practice Address - State:NY
Practice Address - Zip Code:13063-9714
Practice Address - Country:US
Practice Address - Phone:315-638-9844
Practice Address - Fax:315-683-9844
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY594297163W00000X, 163WN0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience