Provider Demographics
NPI:1861460289
Name:GRINER, DEBRA LEE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LEE
Last Name:GRINER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3632 AMERICAN WAY A
Mailing Address - Street 2:MESA PRIMARY CARE
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-3632
Mailing Address - Country:US
Mailing Address - Phone:307-234-6765
Mailing Address - Fax:
Practice Address - Street 1:3632 AMERICAN WAY
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-3632
Practice Address - Country:US
Practice Address - Phone:307-233-7300
Practice Address - Fax:307-233-7301
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY21279.0310363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY314232OtherBCBS
WY830220930-82001-B001OtherTRICARE
WY24391OtherWINHEALTH
WY122920600Medicaid
WY24391OtherWINHEALTH