Provider Demographics
NPI:1528224243
Name:DEUSNER-GRANRUD, MICHELLE KAYE (LMP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KAYE
Last Name:DEUSNER-GRANRUD
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 S ALDER ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-5716
Mailing Address - Country:US
Mailing Address - Phone:509-727-4249
Mailing Address - Fax:
Practice Address - Street 1:2420 W COURT ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-3941
Practice Address - Country:US
Practice Address - Phone:509-545-9160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019067225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist