Provider Demographics
NPI:1003129453
Name:GRUNZINGER, KIMBERLY C (MSN, RN, ACNS-BC)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:C
Last Name:GRUNZINGER
Suffix:
Gender:F
Credentials:MSN, RN, ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 S WOODS MILL RD
Mailing Address - Street 2:SUITE 480 N
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3625
Mailing Address - Country:US
Mailing Address - Phone:314-576-7343
Mailing Address - Fax:314-542-4270
Practice Address - Street 1:222 S WOODS MILL RD
Practice Address - Street 2:SUITE 480 N
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3625
Practice Address - Country:US
Practice Address - Phone:314-576-7343
Practice Address - Fax:314-542-4270
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117782364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health