Provider Demographics
NPI:1619233632
Name:GRANBOIS, CARRIE JEAN (CPNP, RN,)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:JEAN
Last Name:GRANBOIS
Suffix:
Gender:F
Credentials:CPNP, RN,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2530 HORIZON DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-3091
Mailing Address - Country:US
Mailing Address - Phone:651-209-8640
Mailing Address - Fax:651-209-8690
Practice Address - Street 1:2530 HORIZON DR
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-3091
Practice Address - Country:US
Practice Address - Phone:651-209-8640
Practice Address - Fax:651-209-8690
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN20111783363LP0200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care