Healthcare Provider Details

I. General information

NPI: 1710807771
Provider Name (Legal Business Name): ANDREW T GRENNIER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E TACHEVAH DR
PALM SPRINGS CA
92262-5750
US

IV. Provider business mailing address

43570 CROISETTE CT
LA QUINTA CA
92253-4908
US

V. Phone/Fax

Practice location:
  • Phone: 760-464-0023
  • Fax:
Mailing address:
  • Phone: 414-333-0596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN95101682
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: