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NPI Code Detail

MEDICARE: TERRY M GRANLUND NP

MEDICARE: TERRY M GRANLUND NP
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
1363L00000XNurse PractitionerR100009-6MN

General Provider Information

NPI Number : 1447271671
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRY M GRANLUND NP
Provider Business Mailing Address
First Line : 3838 12TH AVE N
Second Line :
City : FARGO
State : ND
Zip : 58102-2931
Country : US
Telephone Number : 701-234-4700
Fax Number : 701-234-4757
Provider Business Practice Location Address
First Line : 3838 12TH AVE N
Second Line :
City : FARGO
State : ND
Zip : 58102-2931
Country : US
Telephone Number : 701-234-4700
Fax Number : 701-234-4757
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2006
Last Update Date : 09/12/2008

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