Provider Demographics
NPI:1073696688
Name:GRUNDIEWSKI, CAROL A (RN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:GRUNDIEWSKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 S HEDLEY ST
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14206-2508
Mailing Address - Country:US
Mailing Address - Phone:716-895-6960
Mailing Address - Fax:
Practice Address - Street 1:7 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14225-2523
Practice Address - Country:US
Practice Address - Phone:716-505-5630
Practice Address - Fax:716-892-1936
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY329444-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse