Provider Demographics
NPI:1699843094
Name:GRANDNER, JOHN J (CRNP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:J
Last Name:GRANDNER
Suffix:
Gender:M
Credentials:CRNP
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2101 EAST JEFFERSON STREET
Mailing Address - Street 2:PPQA MEDICARE COMPLIANCE UNIT 6 WEST
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2414
Mailing Address - Fax:301-388-1740
Practice Address - Street 1:2101 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4908
Practice Address - Country:US
Practice Address - Phone:202-898-5104
Practice Address - Fax:202-898-5474
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCRN47957363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
008532M92Medicare ID - Type Unspecified
S37446Medicare UPIN