Provider Demographics
NPI:1174137434
Name:NGUMI, GRACE NJERI (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:NJERI
Last Name:NGUMI
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:NDUNGU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:435 SHREWSBURY ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1689
Mailing Address - Country:US
Mailing Address - Phone:508-753-5554
Mailing Address - Fax:508-752-7245
Practice Address - Street 1:435 SHREWSBURY ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-1689
Practice Address - Country:US
Practice Address - Phone:508-753-5554
Practice Address - Fax:508-752-7245
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN261116363LP0808X
MA2020039628363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty