Johanna Marie Grassham, RN, CDE, BC-ADM, CNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

56889 Issued in NM

Practice address

1515 Eubank Blvd SE BLDG 832
Albuquerque, NM 87123-3453

Phone

(505) 844-4237

NPI assigned

Jul 11, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Disease Management Clinic

  • Occupational Medicine Clinic/Center
  • Albuquerque, NM
  • NPI 1609164706
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1341964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562803200000",
    "number": "1033474580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 EUBANK BLVD SE BLDG 832",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871233453",
            "telephone_number": "505-844-4237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 EUBANK BLVD SE BLDG 832",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871233453",
            "telephone_number": "505-844-4237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRASSHAM",
        "first_name": "JOHANNA",
        "middle_name": "MARIE",
        "credential": "RN, CDE, BC-ADM, CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-11",
        "last_updated": "2019-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NM",
            "license": "R49987",
            "primary": false
        },
        {
            "code": "163WD0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "NM",
            "license": "2091-0361",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NM",
            "license": "56889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tanika Grant
• Dallas Grassbaugh
• Judy L. Grassbaugh, MA
• Bryan Grassel, PHARMD
• Courtney Grassham
• Bonnie Graston
• Nancy Aeren Grau, PH.D.
• Stephanie Grauke
• Bradley R Graustein, MD
• Jaren P Gravagne, CNP, RNFA

• Nurse Practitioner in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.