Provider Demographics
NPI:1639236375
Name:GROW, DANIELLE MAIRE (CIMI)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MAIRE
Last Name:GROW
Suffix:
Gender:F
Credentials:CIMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 COMMERCIAL STREET
Mailing Address - Street 2:
Mailing Address - City:WHITMAN
Mailing Address - State:MA
Mailing Address - Zip Code:02382
Mailing Address - Country:US
Mailing Address - Phone:781-523-1781
Mailing Address - Fax:
Practice Address - Street 1:1115 WEST CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:508-559-0473
Practice Address - Fax:508-427-5361
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program