Provider Demographics
NPI:1922691724
Name:GRUNERUD, KRISTEN (FNP-BC, DNP)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:GRUNERUD
Suffix:
Gender:F
Credentials:FNP-BC, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12264 MONTURA ROSA PL
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-6048
Mailing Address - Country:US
Mailing Address - Phone:970-980-7908
Mailing Address - Fax:
Practice Address - Street 1:12264 MONTURA ROSA PL
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89138-6048
Practice Address - Country:US
Practice Address - Phone:970-980-7908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV835730363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner