Amy Janine Grandadam, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

181036-30 Issued in WI

Practice address

N1790 N Woodyard Rd
Shell Lake, WI 54871-7801

Phone

(715) 416-5265

NPI assigned

Nov 21, 2022

Last updated

Nov 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Amy Janine Derosia Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1668988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668988800000",
    "number": "1356050033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N1790 N WOODYARD RD",
            "city": "SHELL LAKE",
            "state": "WI",
            "postal_code": "548717801",
            "telephone_number": "715-416-5265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N1790 N WOODYARD RD",
            "city": "SHELL LAKE",
            "state": "WI",
            "postal_code": "548717801",
            "telephone_number": "715-416-5265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANDADAM",
        "first_name": "AMY",
        "middle_name": "JANINE",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-21",
        "last_updated": "2022-11-21",
        "certification_date": "2022-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "181036-30",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "ajgrandam@gmail.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "N1790 N Woodyard Rd",
            "city": "Shell Lake",
            "state": "WI",
            "country_code": "US",
            "postal_code": "548717801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "DEROSIA",
            "middle_name": "JANINE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Registered Nurse in Shell Lake, WI
• Providers in Shell Lake, WI by specialty
• Registered Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2022; 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.