Individual
KELLY JEAN GROSSMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
2303 WYCLIFF ST STE W210, SAINT PAUL, MN 55114-1272
(612) 424-0434
(877) 905-7069
Mailing address
6204 CASCADE PASS, CHANHASSEN, MN 55317-9475
(913) 645-7599
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
12166
MN
Other
Enumeration date
10/09/2024
Last updated
10/09/2024
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