Jacquelyn Alberta Granquist, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

5601004834 Issued in MI

Practice address

325 E H St
Iron Mountain, MI 49801-4760

Phone

(906) 774-3300

NPI assigned

Oct 31, 2006

Sex

Female

Sole proprietor

No

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.

• Dresnick Sterling Emergency Physicians of Maryland PA

  • Emergency Medicine Physician
  • Bel Air, MD
  • NPI 1083664908
  NPD (past)
• Dresnick Sterling Emergency Physicians of Maryland PA

  • Emergency Medicine Physician
  • Havre de Grace, MD
  • NPI 1609826536
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 18, 2019.

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555545600000",
    "number": "1780760744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904 BLUFF AVE",
            "city": "KINGSFORD",
            "state": "MI",
            "postal_code": "498021221",
            "telephone_number": "906-221-0279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 E H ST",
            "city": "IRON MOUNTAIN",
            "state": "MI",
            "postal_code": "498014760",
            "telephone_number": "906-774-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANQUIST",
        "first_name": "JACQUELYN",
        "middle_name": "ALBERTA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-31",
        "last_updated": "2019-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MI",
            "license": "5601004834",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tammie Goldschmidt
• Cassandra Marie Gollakner, DNP, FNP-BC
• Monica Jean Goodreau, OT, CHT
• Jennifer Lynn Gordon
• Leonard Alex Graham, RPH
• Robin Kay Graves
• Rebecca Gray, LMSW
• Great Lakes Recovery Centers
• Green Bay Cardiothoracic & Vascular, LLC
• Greenlund Enterpries, Inc

• All providers in Iron Mountain, MI
• Surgical Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 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.