Provider Demographics
NPI:1508549684
Name:GRACEFUL HEALTH, PLLC
Entity Type:Organization
Organization Name:GRACEFUL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-799-2420
Mailing Address - Street 1:16 ALPINE RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-1821
Mailing Address - Country:US
Mailing Address - Phone:603-799-2420
Mailing Address - Fax:978-228-6775
Practice Address - Street 1:16 ALPINE RD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-1821
Practice Address - Country:US
Practice Address - Phone:603-799-2420
Practice Address - Fax:978-228-6775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty