Provider Demographics
NPI:1174155774
Name:GRABANSKI, CARISSA ASHLEE (CRNA)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:ASHLEE
Last Name:GRABANSKI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:ASHLEE
Other - Last Name:KRUEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2720 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-7023
Mailing Address - Country:US
Mailing Address - Phone:701-740-9388
Mailing Address - Fax:
Practice Address - Street 1:1200 S COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4036
Practice Address - Country:US
Practice Address - Phone:701-780-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR38064367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered