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General NPI Number Information
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NPI Number | 1609837822
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Entity Type | Individual
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Provider Name | RICHARD T GRODE NP
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Gender | Male
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 5405 HELENA RD N
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City | OAKDALE
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State | MN
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Zip | 55128-3051
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Country | US
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Telephone | 651-353-6273
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Fax |
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Provider Business Mailing Address
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Address Line | 5405 HELENA RD N
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City | OAKDALE
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State | MN
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Zip | 55128-3051
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Country | US
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Telephone | 651-353-6273
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1060049
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License Number State | MN
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