PETER MARK GRANDERSON APN FNP-C NPI 1750660528

NPI Information

NPI: 1750660528
Provider Name: PETER MARK GRANDERSON, APN, FNP-C
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
1500 N MOUNT OLIVE ST
SUITE 1
SILOAM SPRINGS, AR
ZIP 72761
Phone: (479) 524-8175
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Peter Mark Granderson, APN, FNP-C is a family nurse practitioner in Siloam Springs, AR. Peter Mark Granderson, APN, FNP-C NPI is 1750660528. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1500 N MOUNT OLIVE ST
SUITE 1
SILOAM SPRINGS, AR
ZIP 72761-509
Phone: (479) 524-8175
Fax: (479) 524-8176

The NPI 1750660528 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Power Mobility Devices.

The enumeration date for this NPI number is 8/11/2011 and was last updated on 9/23/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	A03579	ARKANSAS	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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