Meredith Rose Granholm, IDMT

Primary specialty

Independent Duty Medical TechniciansTaxonomy code 1710I1003X

Practice address

701 Hospital Loop
92 Amds/Sgpe
Fairchild Afb, WA 99011-8704

Phone

(509) 247-5755

Fax

(507) 247-8833

NPI assigned

May 11, 2009

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1242000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242000000000",
    "number": "1750515342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 HOSPITAL LOOP",
            "address_2": "92 AMDS/SGPE",
            "city": "FAIRCHILD AFB",
            "state": "WA",
            "postal_code": "990118704",
            "telephone_number": "509-247-5755",
            "fax_number": "507-247-8833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 HOSPITAL LOOP",
            "address_2": "92 AMDS/SGPE",
            "city": "FAIRCHILD AFB",
            "state": "WA",
            "postal_code": "990118704",
            "telephone_number": "509-247-5755",
            "fax_number": "507-247-8833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANHOLM",
        "first_name": "MEREDITH",
        "middle_name": "ROSE",
        "credential": "IDMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-11",
        "last_updated": "2009-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1003X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Medical Technicians",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Alan Foster, IDMT
• Jaime M Gaither, RN
• Natalie Katherine Garrett, PT, DPT
• Megan Gaschk, PSYD
• Nicholas James Graham, IDMT
• Robert Joshua Grant, D.O.
• Kaylene Goldgrabe Hartt, LCSW
• Tonya M Holstein, MSN-FNP-C
• Stacey Marie Jackson, PSYD
• Caden Daniel Jankowski, IDMT

• Independent Duty Medical Technicians in Fairchild Afb, WA
• Providers in Fairchild Afb, WA by specialty
• Independent Duty Medical Technicians in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2009; 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.