Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 23508-1446 | WY |
NPI | 1003287947 |
---|---|
Provider Name | Mrs. Dana Grenier |
First Address | Rock Springs, WY 82901-4626 |
Second Address | Rock Springs, WY 82901-5649 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2015 |
Last Update Date | 19/08/2020 |