Provider Demographics
NPI:1952511420
Name:GRUNDMAN, RAYMOND E (RN, MSN, FNP-C)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:E
Last Name:GRUNDMAN
Suffix:
Gender:M
Credentials:RN, MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28454 PLANK RD
Mailing Address - Street 2:HWY A
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105
Mailing Address - Country:US
Mailing Address - Phone:414-791-2601
Mailing Address - Fax:
Practice Address - Street 1:3310 N DOWNER AVE
Practice Address - Street 2:NORRIS HEALTH CENTER
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-2933
Practice Address - Country:US
Practice Address - Phone:414-229-4716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily