| Doctor Name: | MR. NICHOLAS J GRANDE |
| NPI Number: | 1316085756 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PAC |
| License Number: | MA052886 |
| Business Practice Address: | Bldg 9040 Fitzsimmons Drive Madigan Army Medical Center Jblm, WA - 98433 |
| Business Phone Number: | 2539679372 |
| Business Fax Number: | 5707591642 |
| Mailing Address: | 608 South 2nd Street,, Apt 6 TACOMA |
| State: | WA |
| Postal Code: | 98405 |
| Phone Number: | 5704063540 |
| Fax Number: | |
| NPI Enumeration Date: | 02/01/2007 |
| NPI Last Update Date: | 09/20/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | MA052886 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |