Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 8672 | MN |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | R205762 | MN |
NPI | 1427710458 |
---|---|
Provider Name | Ms. Emily Rose Grandson |
First Address | Duluth, MN 55805-1951 |
Second Address | Duluth, MN 55805-1950 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2021 |
Last Update Date | 21/10/2021 |