Provider Demographics
NPI:1386466696
Name:GRUNDER, JANNICE (DOULA)
Entity type:Individual
Prefix:
First Name:JANNICE
Middle Name:
Last Name:GRUNDER
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1312
Mailing Address - Street 2:
Mailing Address - City:SOUTH LANCASTER
Mailing Address - State:MA
Mailing Address - Zip Code:01561-1312
Mailing Address - Country:US
Mailing Address - Phone:508-768-7546
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1312
Practice Address - Street 2:
Practice Address - City:SOUTH LANCASTER
Practice Address - State:MA
Practice Address - Zip Code:01561-1312
Practice Address - Country:US
Practice Address - Phone:508-768-7546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula