Provider Demographics
NPI:1679540397
Name:FIMBEL, GRACE (CNM)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:FIMBEL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:FIMBEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2 PRINCESS RD
Mailing Address - Street 2:STE C
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648
Mailing Address - Country:US
Mailing Address - Phone:609-896-0777
Mailing Address - Fax:609-896-3266
Practice Address - Street 1:2 PRINCESS RD
Practice Address - Street 2:STE C
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648
Practice Address - Country:US
Practice Address - Phone:609-896-0777
Practice Address - Fax:609-896-3266
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00038500367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8823308Medicaid
NJ8823308Medicaid
P56180Medicare UPIN