Provider Demographics
NPI:1861034720
Name:GRISPI, MARIAH LOUISE
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:LOUISE
Last Name:GRISPI
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 1:23 OAK ST
Mailing Address - Street 2:
Mailing Address - City:PLYMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:02367-1304
Mailing Address - Country:US
Mailing Address - Phone:781-635-0979
Mailing Address - Fax:
Practice Address - Street 1:330 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02188-2932
Practice Address - Country:US
Practice Address - Phone:781-626-5160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAF08190360363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAN0134435101OtherTUFTS HEALTH DIRECT