Provider Demographics
NPI:1184657702
Name:GRANDIERI-FLUKER, RENEE (APN)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:
Last Name:GRANDIERI-FLUKER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 CHEVRON ST
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-6727
Mailing Address - Country:US
Mailing Address - Phone:702-544-9634
Mailing Address - Fax:
Practice Address - Street 1:2780 HOMESTEAD RD
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-5399
Practice Address - Country:US
Practice Address - Phone:775-727-7959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN00193363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1184657702Medicaid
NVAPRN00193OtherSTATE LICENSE