Provider Demographics
NPI:1548811334
Name:GRABAU, MARILYN J (NP-C)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:J
Last Name:GRABAU
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:81 BURRILL AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-2727
Mailing Address - Country:US
Mailing Address - Phone:508-697-4230
Mailing Address - Fax:508-531-6193
Practice Address - Street 1:351 GREAT HILL DRIVE BRIDGEWATER STATE UNIVERSITY
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02325-0001
Practice Address - Country:US
Practice Address - Phone:508-531-2855
Practice Address - Fax:508-531-6193
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN189557363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily