MEDICARE: MRS. CARRIE JEAN GRANBOIS CNP, APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	20111783	MN
2	363LP0200X	Pediatric Nurse Practitioner	20111783	MN

General Provider Information

NPI Number	:	1619233632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARRIE JEAN GRANBOIS CNP, APRN

Provider Business Mailing Address
First Line	:	2911 26TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-1555
Country	:	US
Telephone Number	:	612-886-3626
Fax Number	:	612-886-3627

Provider Business Practice Location Address
First Line	:	2911 26TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-1555
Country	:	US
Telephone Number	:	612-886-3626
Fax Number	:	612-886-3627

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2012
Last Update Date	:	07/02/2026

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