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General NPI Number Information
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NPI Number | 1396778569
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Entity Type | Individual
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Provider Name | GRANT PALM CRNA
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Gender | Male
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 12/10/2015
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Provider Practice Location Address
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Address Line | 320 ALPENGLOW LANE
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City | LIVINGSTON
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State | MT
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Zip | 59047
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Country | US
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Telephone | 406-222-3541
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Fax | 406-823-6287
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Provider Business Mailing Address
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Address Line | 320 ALPENGLOW LANE
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City | LIVINGSTON
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State | MT
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Zip | 59047
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Country | US
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Telephone | 406-222-3541
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Fax | 406-823-6630
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN19560
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License Number State | MT
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