Individual
LISA KAREN MARIE DEGRANDIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1493 CAMBRIDGE ST, CAMBRIDGE, MA 02139-1047
(617) 665-1000
Mailing address
100 FULTON ST APT 1R, BOSTON, MA 02109-1429
(781) 521-4494
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
207027
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN207027
RN LICENSE
MA
Enumeration date
08/07/2019
Last updated
08/07/2019
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