Provider Demographics
NPI:1457615155
Name:GRUENHAGEN, CHANTEE SEUNG (NP)
Entity Type:Individual
Prefix:MRS
First Name:CHANTEE
Middle Name:SEUNG
Last Name:GRUENHAGEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:CHANTEE
Other - Middle Name:
Other - Last Name:SEUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:737 NORTH BROADWAY
Mailing Address - Street 2:SANFORD HEALTH
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58122
Mailing Address - Country:US
Mailing Address - Phone:701-234-2301
Mailing Address - Fax:701-234-2130
Practice Address - Street 1:737 NORTH BROADWAY
Practice Address - Street 2:SANFORD UROLOGY CLINIC
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58122
Practice Address - Country:US
Practice Address - Phone:701-234-2301
Practice Address - Fax:701-234-2130
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR307502088P0231X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology