Provider Demographics
NPI:1639931637
Name:GRUNDEN, MIGNON (RN BSN)
Entity Type:Individual
Prefix:MRS
First Name:MIGNON
Middle Name:
Last Name:GRUNDEN
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 PHILO RD
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14903-1051
Mailing Address - Country:US
Mailing Address - Phone:607-735-3300
Mailing Address - Fax:
Practice Address - Street 1:459 PHILO RD
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14903-1051
Practice Address - Country:US
Practice Address - Phone:607-735-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY468740163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool