Healthcare Provider Details

I. General information

NPI: 1962325712
Provider Name (Legal Business Name): ABIGAIL GRANHOLM
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 1ST ST SW
ROCHESTER MN
55905-0002
US

IV. Provider business mailing address

200 1ST ST SW
ROCHESTER MN
55905-0002
US

V. Phone/Fax

Practice location:
  • Phone: 507-284-3211
  • Fax:
Mailing address:
  • Phone: 507-284-3211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number2319647
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: