Provider Demographics
NPI:1124484084
Name:GRASSETTI, MARIE ALEXANDRINE (RN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:ALEXANDRINE
Last Name:GRASSETTI
Suffix:
Gender:F
Credentials:RN, CPNP-PC
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:ALEXANDRINE
Other - Last Name:DIONNE-CLAYCOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CPNP-PC
Mailing Address - Street 1:549 AUDUBON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-3401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200-214 WEST 135TH STREET
Practice Address - Street 2:ROOM 007
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030
Practice Address - Country:US
Practice Address - Phone:646-317-0292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-07
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382845363LP0200X
NY706098163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse