Provider Demographics
NPI:1184297558
Name:PFEIFER, GRACE A (PMHNP)
Entity type:Individual
Prefix:MISS
First Name:GRACE
Middle Name:A
Last Name:PFEIFER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 PINE RIDGE I
Mailing Address - Street 2:
Mailing Address - City:HALFMOON
Mailing Address - State:NY
Mailing Address - Zip Code:12065-5636
Mailing Address - Country:US
Mailing Address - Phone:518-892-7721
Mailing Address - Fax:
Practice Address - Street 1:427 GUY PARK AVE STE 1
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-1060
Practice Address - Country:US
Practice Address - Phone:518-842-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403492363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health