Provider Demographics
NPI:1013563261
Name:GRANSDEN, CHRISTINE L (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:L
Last Name:GRANSDEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 E BROOMFIELD ST STE A
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-5427
Mailing Address - Country:US
Mailing Address - Phone:989-400-4588
Mailing Address - Fax:
Practice Address - Street 1:1621 E BROOMFIELD ST STE A
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-5427
Practice Address - Country:US
Practice Address - Phone:989-400-4588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704259568363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner