Individual
MR. GRANT MICHAEL BLAUVELT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSN, FNP-BC
Contact information
Practice address
7900 W JEFFERSON BLVD STE 201, FORT WAYNE, IN 46804-4128
(260) 432-2297
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 479-3514
(260) 479-3520
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71011228A
IN
Other
Enumeration date
06/22/2021
Last updated
12/17/2021
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