MEDICARE: MRS. DEBRA LEE GRINER FNP-C

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	363LF0000X	Family Nurse Practitioner	21279.0310	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	314232	OTHER	WY	BCBS
2	830220930-82001-B001	OTHER	WY	TRICARE
3	24391	OTHER	WY	WINHEALTH
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861460289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBRA LEE GRINER FNP-C

Provider Business Mailing Address
First Line	:	3632 AMERICAN WAY A
Second Line	:	MESA PRIMARY CARE
City	:	CASPER
State	:	WY
Zip	:	82604-3632
Country	:	US
Telephone Number	:	307-234-6765
Fax Number	:

Provider Business Practice Location Address
First Line	:	3632 AMERICAN WAY
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82604-3632
Country	:	US
Telephone Number	:	307-233-7300
Fax Number	:	307-233-7301

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	01/11/2016

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