Individual
CARLY MARIE GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8170 33RD AVE S, BLOOMINGTON, MN 55425-4516
(952) 883-6000
Mailing address
8170 33RD AVE S, BLOOMINGTON, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
35680
MN
Other
Enumeration date
03/27/2023
Last updated
05/22/2025
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