Healthcare Provider Details

I. General information

NPI: 1306899257
Provider Name (Legal Business Name): KAREN B GRUNEWALD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 CORNELIA ST SUITE 101
PLATTSBURGH NY
12901-2318
US

IV. Provider business mailing address

99 HAWKES WAY
COLCHESTER VT
05446-4425
US

V. Phone/Fax

Practice location:
  • Phone: 518-562-7990
  • Fax:
Mailing address:
  • Phone: 802-578-4613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number101-0029403
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF303176
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: