Healthcare Provider Details

I. General information

NPI: 1437911187
Provider Name (Legal Business Name): MARY KATHERINE GRONDIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 6TH AVE S
BIRMINGHAM AL
35233-2110
US

IV. Provider business mailing address

1808 7TH AVE S
BIRMINGHAM AL
35233-1912
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-2006
  • Fax: 205-934-0024
Mailing address:
  • Phone: 205-934-2006
  • Fax: 205-934-0024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-186383
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: