Provider Demographics
NPI:1205595386
Name:GROSLAND, JENNIFER GAIL GRABER (FNP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GAIL GRABER
Last Name:GROSLAND
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:GAIL
Other - Last Name:JULSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:12951 ALMERIA TRL
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-4854
Mailing Address - Country:US
Mailing Address - Phone:507-313-9249
Mailing Address - Fax:
Practice Address - Street 1:15051 GALAXIE AVE
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-6987
Practice Address - Country:US
Practice Address - Phone:507-313-9249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8809363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily