Provider Demographics
NPI:1336602671
Name:GRUNKEMEYER, GAIL M (NP)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:M
Last Name:GRUNKEMEYER
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:18818 HILLCREST ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3340
Mailing Address - Country:US
Mailing Address - Phone:248-346-3582
Mailing Address - Fax:
Practice Address - Street 1:19229 MACK AVE STE 24
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-2857
Practice Address - Country:US
Practice Address - Phone:313-884-5522
Practice Address - Fax:313-884-6054
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2020-01-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704276376363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care