Active NPI
Nancy E Grimsrud, RN CPNP
- Pediatric Nurse Practitioner
- Bethel, AK
National Provider Identifier
1417062498
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 1083
- Practice address
- 700 Chief Eddie Hoffman Highway
Bethel, AK 99559 - Phone
- (907) 543-6563
- NPI assigned
- Aug 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | R0927633 | MN | |
| Pediatric Nurse Practitioner | 363LP0200X | 1083 | AK | Primary |
Addresses
Primary practice location
700 Chief Eddie Hoffman Highway
Bethel, AK 99559
Mailing address
700 Chief Eddie Hoffman Highway
Bethel, AK 99559
Phone (907) 543-6300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 081718000 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Pediatric Nurse Practitioner, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1083 | AK | MD | Social Worker |
| R0927633 | MN | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156032000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1303344000000",
"number": "1417062498",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 CHIEF EDDIE HOFFMAN HIGHWAY",
"city": "BETHEL",
"state": "AK",
"postal_code": "99559",
"telephone_number": "907-543-6300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 CHIEF EDDIE HOFFMAN HIGHWAY",
"city": "BETHEL",
"state": "AK",
"postal_code": "99559",
"telephone_number": "907-543-6563"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRIMSRUD",
"first_name": "NANCY",
"middle_name": "E",
"credential": "RN CPNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-20",
"last_updated": "2011-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "MN",
"license": "R0927633",
"primary": false
},
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "AK",
"license": "1083",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "081718000",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bethel, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.