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General NPI Number Information
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NPI Number | 1831435403
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Entity Type | Individual
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Provider Name | CHRISTINA ANN PAYTON GRUNWALDT FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/29/2012
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Last Update Date | 03/30/2015
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Provider Practice Location Address
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Address Line | 540 N SCHMALE RD
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City | CAROL STREAM
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State | IL
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Zip | 60188-1867
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Country | US
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Telephone | 855-925-4733
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 E VOORHEES ST
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City | DANVILLE
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State | IL
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Zip | 61834-4509
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209-009888
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License Number State | IL
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