Healthcare Provider Details

I. General information

NPI: 1275459265
Provider Name (Legal Business Name): GRANT WOSICK EMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5305 MAC DR
GRAND FORKS ND
58201-3007
US

IV. Provider business mailing address

5305 MAC DR
GRAND FORKS ND
58201-3007
US

V. Phone/Fax

Practice location:
  • Phone: 701-331-4771
  • Fax:
Mailing address:
  • Phone: 701-331-4771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number8244-6675-3614
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: