MEDICARE: MS. PAM SUE GRASSMIDT RNC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	332355	CA
2	363LA2200X	Adult Health Nurse Practitioner	332355	CA

General Provider Information

NPI Number	:	1073735163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAM SUE GRASSMIDT RNC

Provider Business Mailing Address
First Line	:	1552 COFFEE RD
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95355-3107
Country	:	US
Telephone Number	:	209-521-4372
Fax Number	:	209-523-2005

Provider Business Practice Location Address
First Line	:	1552 COFFEE RD
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95355-3107
Country	:	US
Telephone Number	:	209-521-4372
Fax Number	:	209-523-2005

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	09/11/2025

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