Individual
JACQUELYN ALBERTA GRANQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
325 E H ST, IRON MOUNTAIN, MI 49801-4760
(906) 774-3300
Mailing address
904 BLUFF AVE, KINGSFORD, MI 49802-1221
(906) 221-0279
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
5601004834
MI
Other
Enumeration date
10/31/2006
Last updated
04/18/2019
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