Provider Demographics
NPI:1689177867
Name:GRISSOM, AMBER NICOLE (DNP, AGNP-C)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:NICOLE
Last Name:GRISSOM
Suffix:
Gender:F
Credentials:DNP, AGNP-C
Other - Prefix:DR
Other - First Name:AMBER
Other - Middle Name:NICOLE
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, AGNP-C
Mailing Address - Street 1:43 WHITING HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1006
Mailing Address - Country:US
Mailing Address - Phone:207-973-5000
Mailing Address - Fax:207-973-5042
Practice Address - Street 1:302 HUSSON AVE STE 1
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3373
Practice Address - Country:US
Practice Address - Phone:207-947-6141
Practice Address - Fax:207-947-6720
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP201287363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care