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NPI Code Detail

MEDICARE: MARILOU GRAINGER CRNA

MEDICARE: MARILOU GRAINGER CRNA
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
1367500000XCertified Registered Nurse Anesthetist080485MO

General Provider Information

NPI Number : 1376514414
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARILOU GRAINGER CRNA
Provider Business Mailing Address
First Line : 85 TERRACE LN
Second Line :
City : WASHINGTON
State : MO
Zip : 63090-6203
Country : US
Telephone Number : 636-239-8000
Fax Number :
Provider Business Practice Location Address
First Line : 901 E 5TH ST
Second Line :
City : WASHINGTON
State : MO
Zip : 63090-3127
Country : US
Telephone Number : 636-239-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2006
Last Update Date : 07/08/2007

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Directions to “ MARILOU GRAINGER CRNA” Practice Location

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