Individual
MS. AMY JOELLE GRANQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
591 KENNEDY RD, LEEDS, MA 01053-9756
(215) 833-9338
Mailing address
PO BOX 423, LEEDS, MA 01053-0423
(215) 833-9338
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN535352
PA
367500000X
Certified Registered Nurse Anesthetist
Primary
2315447
MA
367500000X
Certified Registered Nurse Anesthetist
RN535352
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN535352
RN LICENSE
PA
Enumeration date
02/26/2008
Last updated
03/15/2023
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