Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | AP2227 | AZ |
NPI | 1013931047 |
---|---|
Provider Name | Ms. Kristi K. Grenda |
First Address | Phoenix, AZ 85004-1425 |
Second Address | Phoenix, AZ 85004-1471 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 09/07/2014 |