Provider Demographics
NPI:1619313178
Name:PROPPER, GRACE (MS, RN, CPNP, NNP-BC)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:PROPPER
Suffix:
Gender:F
Credentials:MS, RN, CPNP, NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 NORTH OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738
Mailing Address - Country:US
Mailing Address - Phone:631-282-8450
Mailing Address - Fax:631-320-1300
Practice Address - Street 1:2880 NORTH OCEAN AVE
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738
Practice Address - Country:US
Practice Address - Phone:631-282-8450
Practice Address - Fax:631-320-1300
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF350227-1363LN0005X
NYF380995-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care