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General NPI Number Information
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NPI Number | 1275818692
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Entity Type | Individual
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Provider Name | JENIFER ANN GRISSOM CNP
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Gender | Female
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Dates
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Enumeration Date | 10/17/2011
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 13045 FALCON DR STE 100
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City | BAXTER
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State | MN
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Zip | 56425-4201
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Country | US
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Telephone | 218-829-9307
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Fax |
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Provider Business Mailing Address
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Address Line | 13045 FALCON DR STE 100
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City | BAXTER
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State | MN
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Zip | 56425-4201
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Country | US
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Telephone | 218-829-9307
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Fax | 218-829-7649
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 10032
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 16370
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A105481
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License Number State | IA
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