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NPI Code Detail

MEDICARE: MS. CHRISTINE LYNN GRANLUND

MEDICARE: MS. CHRISTINE LYNN GRANLUND
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
1314000000XSkilled Nursing Facility201509MN

General Provider Information

NPI Number : 1538318761
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CHRISTINE LYNN GRANLUND
Provider Business Mailing Address
First Line : 2043 189TH AVE NE
Second Line :
City : EAST BETHEL
State : MN
Zip : 55011-9552
Country : US
Telephone Number : 763-434-1698
Fax Number :
Provider Business Practice Location Address
First Line : 3130 GRIMES AVE N
Second Line :
City : ROBBINSDALE
State : MN
Zip : 55422-3217
Country : US
Telephone Number : 763-540-2737
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2008
Last Update Date : 09/11/2008

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