Provider Demographics
NPI:1457037632
Name:SKINNER, GRACE (PA-C)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:SKINNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:GLENNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:299 CAREW ST STE 419
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2361
Mailing Address - Country:US
Mailing Address - Phone:413-737-7951
Mailing Address - Fax:413-413-7470
Practice Address - Street 1:299 CAREW ST STE 419
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2361
Practice Address - Country:US
Practice Address - Phone:413-737-7951
Practice Address - Fax:413-413-7470
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant