Grace L Andersen, RN

Individual provider Active NPI Registered Nurse · Saint James, NY

NPI 1992978613 · NPPES record last updated Apr 3, 2008

Key facts

NPI
1992978613
Entity type
Individual (NPI type 1)
Primary specialty
Registered Nurse 163W00000X
License
568419 (NY)
Practice address
52 Vanderbilt Ave
Saint James, NY 11780-1732
Phone
(631) 584-9031
NPI assigned
Apr 3, 2008
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

LicenseStateTypeSpecialty
568419NYMDRegistered Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 568419 NY Yes

Addresses

Primary practice location

52 Vanderbilt Ave
Saint James, NY 11780-1732

Mailing address

52 Vanderbilt Ave
Saint James, NY 11780-1732
Phone (631) 584-9031

Other providers in Saint James, NY

All providers in Saint James, NY · Registered Nurse in New York

Sources for this page

Verify at the official NPI Registry.