Individual
CARMEN RENEE GRANDE HENKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNNP
Contact information
Practice address
347 NORTH SMITH AVENUE, CHILDRENS SPECIALTY CLINIC NICU, ST PAUL, MN 55102
(651) 220-6210
(651) 220-7777
Mailing address
2910 CENTRE POINTE DRIVE, 35 121A, ROSEVILLE, MN 55113
(651) 855-2327
(651) 855-2310
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
R1475155
MN
363LN0005X
Critical Care Neonatal Nurse Practitioner
R1475155
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
318656300
—
MN
Enumeration date
04/22/2006
Last updated
12/19/2016
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