Provider Demographics
NPI:1811606692
Name:PEASE, GRACE MERRIFIELD (CPM)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:MERRIFIELD
Last Name:PEASE
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 FARM LN
Mailing Address - Street 2:
Mailing Address - City:CORNISH
Mailing Address - State:ME
Mailing Address - Zip Code:04020-3270
Mailing Address - Country:US
Mailing Address - Phone:207-205-5263
Mailing Address - Fax:
Practice Address - Street 1:11 RIVER RD
Practice Address - Street 2:
Practice Address - City:LIMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04049-3709
Practice Address - Country:US
Practice Address - Phone:207-329-2111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECPM772176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife