Kim Grennan, RN
Individual provider Active NPI Registered Nurse · Bayport, NY
NPI 1619308012 · NPPES record last updated Dec 10, 2013
Key facts
- NPI
- 1619308012
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 462749 (NY)
- Practice address
- 427 Terrace Rd
Bayport, NY 11705-1526 - Phone
- (631) 681-3911
- NPI assigned
- Dec 10, 2013
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 462749 | NY | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 462749 | NY | Yes |
Addresses
Primary practice location
427 Terrace Rd
Bayport, NY 11705-1526
Mailing address
427 Terrace Rd
Bayport, NY 11705-1526
Phone (631) 681-3911
Other providers in Bayport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 10, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.