Individual
PETER MARK GRANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APN, FNP-C
Contact information
Practice address
1500 N MOUNT OLIVE ST, SUITE 1, SILOAM SPRINGS, AR 72761-9509
(479) 524-8175
(479) 524-8176
Mailing address
614 E EMMA AVENUE, SUITE 300, SPRINGDALE, AR 72764-4469
(479) 751-7417
(479) 751-4898
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
A03579
AR
Other
Enumeration date
08/11/2011
Last updated
09/23/2016
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