Healthcare Provider Details

I. General information

NPI: 1083176630
Provider Name (Legal Business Name): KRISTIN MARIE GRAMMATICO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E FLORENCE BLVD
CASA GRANDE AZ
85122-5303
US

IV. Provider business mailing address

9814 E PALLADIUM DR
MESA AZ
85212-8750
US

V. Phone/Fax

Practice location:
  • Phone: 520-381-6150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License NumberRN182011
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number277313
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: