Individual
KRISTIE MICHELLE GRIMES-MALLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
45 DIMOCK ST, ROXBURY, MA 02119-1208
(617) 442-8800
(617) 541-8334
Mailing address
34 HOWE ST UNIT 1, BOSTON, MA 02125-2143
(617) 828-9941
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN2335640
MA
363L00000X
Nurse Practitioner
Primary
RN2335640
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110164451A
—
MA
Enumeration date
07/22/2020
Last updated
11/16/2020
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