Provider Demographics
NPI:1558067686
Name:GRUNDY, KATE CHAVONNE (CNP)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:CHAVONNE
Last Name:GRUNDY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 INDUSTRIAL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-3473
Mailing Address - Country:US
Mailing Address - Phone:508-477-4282
Mailing Address - Fax:
Practice Address - Street 1:5 INDUSTRIAL DR STE 100
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3473
Practice Address - Country:US
Practice Address - Phone:508-477-4282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2322005363LF0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse