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General NPI Number Information
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NPI Number | 1518793447
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Entity Type | Individual
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Provider Name | AMANDA RASHELLE GROMMESCH BSN, RN, PHN
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Gender | Female
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 4801 VETERANS DR
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City | SAINT CLOUD
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State | MN
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Zip | 56303-2015
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Country | US
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Telephone | 320-252-1670
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Fax |
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Provider Business Mailing Address
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Address Line | 64 LINDEN AVE S
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City | MAPLE LAKE
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State | MN
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Zip | 55358-4580
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Country | US
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Telephone | 952-994-5126
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Fax |
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 2481723
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 364SC1501X
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Taxonomy Name | Community Health/Public Health Clinical Nurse Specialist
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License Number | 32572
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2481723
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License Number State | MN
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