Provider Demographics
NPI:1790969160
Name:GRANSBERY, COLIN JAMES (RN)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:JAMES
Last Name:GRANSBERY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7526 NORWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3646
Mailing Address - Country:US
Mailing Address - Phone:816-589-3503
Mailing Address - Fax:
Practice Address - Street 1:7526 NORWOOD ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3646
Practice Address - Country:US
Practice Address - Phone:816-589-3503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006033846163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency