Individual
SIERRA MANDELA GROTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
561 FRENN AVE, RED WING, MN 55066-3907
(651) 403-3176
Mailing address
561 FRENN AVE, RED WING, MN 55066-3907
(651) 403-3176
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2245452
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2245452
REGISTERED NURSING LICENSE
MN
Enumeration date
08/25/2021
Last updated
08/25/2021
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