Active NPI
Rosemary Grullon
- Physician Assistant
- Mint Hill, NC
National Provider Identifier
1720101306
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0010-00901
- Practice address
- 11304 Hawthorne Dr
Suite 100
Mint Hill, NC 28227-9425 - Phone
- (704) 545-6400
- NPI assigned
- Apr 9, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0010-00901 | NC | Primary |
Addresses
Primary practice location
11304 Hawthorne Dr
Suite 100
Mint Hill, NC 28227-9425
Mailing address
11304 Hawthorne Dr
Mint Hill, NC 28227-9425
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0010-00901 | NC | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1549929600000",
"number": "1720101306",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11304 HAWTHORNE DR",
"city": "MINT HILL",
"state": "NC",
"postal_code": "282279425"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11304 HAWTHORNE DR",
"address_2": "SUITE 100",
"city": "MINT HILL",
"state": "NC",
"postal_code": "282279425",
"telephone_number": "704-545-6400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRULLON",
"first_name": "ROSEMARY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-09",
"last_updated": "2019-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "0010-00901",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mint Hill, NC
- GPS Pharmacy Solutions LLC
- Graced 4 Healing Counseling, PLLC
- Greg Ott'S Center for Physical Therapy and Sports Performance, LLC
- Linda Gross, MS, RD,LDN
- Pushpa Lall Gross, M.D.
- Brian Guardado
- Diana Guevara
- Robert Andrew Guskiewicz II, PHARM.D.
- Rachel Christine Gwin, PH.D., BCBA
- Shequita Raynea Haley Ross
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 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.