Individual
MR. NICHOLAS J GRANDE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
1227 E RUSHOLME ST, DAVENPORT, IA 52803-2459
(563) 421-1000
Mailing address
650 HUEBNER RD, FORT RILEY, KS 66442-4030
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
02/01/2007
Last updated
02/16/2023
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