Provider Demographics
NPI:1366170219
Name:HALLENBECK, GRACE (DNP-FNP)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:HALLENBECK
Suffix:
Gender:F
Credentials:DNP-FNP
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:OUELLETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:133 ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01267-2930
Mailing Address - Country:US
Mailing Address - Phone:603-566-2742
Mailing Address - Fax:
Practice Address - Street 1:7237 US-7
Practice Address - Street 2:
Practice Address - City:POWNAL
Practice Address - State:VT
Practice Address - Zip Code:05261
Practice Address - Country:US
Practice Address - Phone:802-681-2780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0135597363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty