Provider Demographics
NPI:1942247218
Name:GRENIER, MARC (CRNA)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:GRENIER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10859 EMERALD COAST PKWY W
Mailing Address - Street 2:STE 204-187
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32550-7869
Mailing Address - Country:US
Mailing Address - Phone:601-569-1790
Mailing Address - Fax:
Practice Address - Street 1:616 19TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1528
Practice Address - Country:US
Practice Address - Phone:706-494-4262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA153270367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP38142Medicare UPIN
SC43BBCCVMedicare PIN