Provider Demographics
NPI:1780936492
Name:GRUN, TERRI LYNN (LPN)
Entity type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:LYNN
Last Name:GRUN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:TERRI
Other - Middle Name:LYNN
Other - Last Name:GRUN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:2524 OAK VIEW RD
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-4067
Mailing Address - Country:US
Mailing Address - Phone:715-732-1526
Mailing Address - Fax:
Practice Address - Street 1:2524 OAK VIEW RD
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-4067
Practice Address - Country:US
Practice Address - Phone:715-732-1526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI304732-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse