Provider Demographics
NPI:1205384500
Name:GRASSFIELD, MARJORIE DOLORES (BSHCA/LPN)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:DOLORES
Last Name:GRASSFIELD
Suffix:
Gender:F
Credentials:BSHCA/LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 CHARLES ST # 506
Mailing Address - Street 2:
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566-7605
Mailing Address - Country:US
Mailing Address - Phone:845-649-1563
Mailing Address - Fax:
Practice Address - Street 1:62 CHARLES ST # 506
Practice Address - Street 2:
Practice Address - City:PINE BUSH
Practice Address - State:NY
Practice Address - Zip Code:12566-7605
Practice Address - Country:US
Practice Address - Phone:845-649-1563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224298164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse