| NPI | 1962921049 |
|---|---|
| Former Name | HEIDI GRONDAHL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2017-09-11 |
| Last Update Date | 2025-06-04 |