Provider Demographics
NPI:1821393018
Name:MARVIN, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:MARVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ALPINE RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-1821
Mailing Address - Country:US
Mailing Address - Phone:603-799-2420
Mailing Address - Fax:978-228-6775
Practice Address - Street 1:16 ALPINE RD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-1821
Practice Address - Country:US
Practice Address - Phone:603-799-2420
Practice Address - Fax:978-228-6775
Is Sole Proprietor?:No
Enumeration Date:2011-01-19
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN264965363LF0000X
NH055837-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily