Provider Demographics
NPI:1417999871
Name:GRABAU, ANGELYNN MAIRE (MSN RN CNP)
Entity Type:Individual
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First Name:ANGELYNN
Middle Name:MAIRE
Last Name:GRABAU
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Gender:F
Credentials:MSN RN CNP
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Mailing Address - Street 1:P.O. BOX 209036
Mailing Address - Street 2:SHRINERS HOSPITALS FOR CHILDREN TWIN CITIES
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-9036
Mailing Address - Country:US
Mailing Address - Phone:813-281-8478
Mailing Address - Fax:813-281-8113
Practice Address - Street 1:2025 E RIVER PARKWAY
Practice Address - Street 2:SHRINERS HOSPITALS FOR CHILDREN TWIN CITIES
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-3604
Practice Address - Country:US
Practice Address - Phone:612-596-6191
Practice Address - Fax:612-339-7634
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2011-03-29
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Provider Licenses
StateLicense IDTaxonomies
MNR1368783363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
P79752Medicare UPIN