Healthcare Provider Details

I. General information

NPI: 1184657702
Provider Name (Legal Business Name): RENEE GRANDIERI-FLUKER A.P.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 HOMESTEAD RD
PAHRUMP NV
89048-5399
US

IV. Provider business mailing address

181 CHEVRON ST
PAHRUMP NV
89048-6727
US

V. Phone/Fax

Practice location:
  • Phone: 775-727-7959
  • Fax:
Mailing address:
  • Phone: 702-544-9634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAPN00193
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: