Provider Demographics
NPI:1629733100
Name:LANDREAU-GRASMUCK, TESSA MICAELA (CPM)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:MICAELA
Last Name:LANDREAU-GRASMUCK
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 394
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03235-0394
Mailing Address - Country:US
Mailing Address - Phone:215-901-6233
Mailing Address - Fax:
Practice Address - Street 1:254 N STATE ST UNIT D
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3224
Practice Address - Country:US
Practice Address - Phone:215-901-6233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife