Provider Demographics
NPI:1134908163
Name:STAINES, GRACE GILLETTE (FNP-BC)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:GILLETTE
Last Name:STAINES
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:MARGARET
Other - Last Name:GILLETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01944-1613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1075 ASYLUM AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2455
Practice Address - Country:US
Practice Address - Phone:978-578-3974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT211972363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily