Provider Demographics
NPI:1558372292
Name:GRENIER-MULLINS, DEANNA CAROLE (NP)
Entity Type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:CAROLE
Last Name:GRENIER-MULLINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:DEANNA
Other - Middle Name:CAROLE
Other - Last Name:MAPLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:5855 SILVER CREEK VALLEY RD # 171-3N5
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-1059
Mailing Address - Country:US
Mailing Address - Phone:408-574-9173
Mailing Address - Fax:650-858-8905
Practice Address - Street 1:3801 MIRANDA AVE
Practice Address - Street 2:HBPC-SAN JOSE CLINIC
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1207
Practice Address - Country:US
Practice Address - Phone:408-363-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 502181, NPF 7829363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MM2323929OtherDEA NUMBER