Provider Demographics
NPI:1427692102
Name:GRINNELL, MEGAN RENEE
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:RENEE
Last Name:GRINNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 DONZI TRL
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:CO
Mailing Address - Zip Code:80816-9226
Mailing Address - Country:US
Mailing Address - Phone:719-238-0633
Mailing Address - Fax:
Practice Address - Street 1:243 DONZI TRL
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:CO
Practice Address - Zip Code:80816-9226
Practice Address - Country:US
Practice Address - Phone:719-238-0633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1631032163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse