Provider Demographics
NPI:1740890573
Name:GRAINGER, KRISTY MARIE (FNP)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:MARIE
Last Name:GRAINGER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WALL ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-4147
Mailing Address - Country:US
Mailing Address - Phone:508-331-0737
Mailing Address - Fax:
Practice Address - Street 1:55 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WINCHENDON
Practice Address - State:MA
Practice Address - Zip Code:01475-1820
Practice Address - Country:US
Practice Address - Phone:978-297-2311
Practice Address - Fax:978-297-4173
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA390200000X
MARN270461363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program