Grant Gullickson, PA-C Valid NPI
Individual provider · Physician Assistant · New Brighton, MN
- NPI
- 1770279408
- Type
- Individual (Type 1)
- Primary specialty
- Physician Assistant
- Specialty group
- Physician Assistants & Advanced Practice Nursing Providers
- Taxonomy code
- 363A00000X
- License number
- 14410 (MN)
- Sex
- Male
- Sole proprietor
- Yes
- Enumerated
- 2023-04-14
- Last updated
- 2023-04-14
Practice location
1900 Silver Lake Rd Nw Ste 110
New Brighton, MN 55112-1789
(651) 628-9566