Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | ME00030701 | NJ |
NPI | 1023053378 |
---|---|
Provider Name | Rachel Grencavich |
First Address | Marlton, NJ 08053-4197 |
Second Address | Mount Holly, NJ 08060-2099 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2006 |
Last Update Date | 20/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P24941 | (02) | NJ |