Provider Demographics
NPI:1174776520
Name:GRINNELL, DEBORAH FAITH DYMPHNA (RN)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:FAITH DYMPHNA
Last Name:GRINNELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 HILLMAN ST.
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-5219
Mailing Address - Country:US
Mailing Address - Phone:508-992-2696
Mailing Address - Fax:
Practice Address - Street 1:119 HILLMAN ST.
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-5219
Practice Address - Country:US
Practice Address - Phone:508-992-2696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213893163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse