Provider Demographics
NPI:1891753828
Name:GRANDT, NANCY C (CNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:C
Last Name:GRANDT
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 BEAM AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1163
Mailing Address - Country:US
Mailing Address - Phone:651-232-7800
Mailing Address - Fax:651-232-7826
Practice Address - Street 1:1655 BEAM AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1163
Practice Address - Country:US
Practice Address - Phone:651-232-7800
Practice Address - Fax:651-232-7826
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR096713-0363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNS95536Medicare UPIN