Provider Demographics
NPI:1073735163
Name:GRASSMIDT, PAM SUE (RNC)
Entity Type:Individual
Prefix:MS
First Name:PAM
Middle Name:SUE
Last Name:GRASSMIDT
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1552 COFFEE RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3107
Mailing Address - Country:US
Mailing Address - Phone:209-521-4372
Mailing Address - Fax:209-523-2005
Practice Address - Street 1:1552 COFFEE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3107
Practice Address - Country:US
Practice Address - Phone:209-521-4372
Practice Address - Fax:209-523-2005
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332355363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health