Provider Demographics
NPI:1497008247
Name:HAN, MARIE GRACE (FNP-C)
Entity Type:Individual
Prefix:DR
First Name:MARIE GRACE
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 FOLEY ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-1213
Mailing Address - Country:US
Mailing Address - Phone:857-282-0777
Mailing Address - Fax:
Practice Address - Street 1:440 FOLEY ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-1213
Practice Address - Country:US
Practice Address - Phone:857-282-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001957363LF0000X
MARN2377648363L00000X
LAAP07040363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1497008247Medicaid
NVV111137Medicare PIN