Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 76945 | KS |
NPI | 1508236365 |
---|---|
Provider Name | Charis Grosdidier |
First Address | Lawrence, KS 66044-1360 |
Second Address | Lawrence, KS 66044-1333 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2015 |
Last Update Date | 22/12/2021 |