Provider Demographics
NPI:1467335075
Name:GRANDINETTI, JENNA ANNE
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:ANNE
Last Name:GRANDINETTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-9484
Mailing Address - Country:US
Mailing Address - Phone:414-882-1698
Mailing Address - Fax:
Practice Address - Street 1:N69W5269 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-2103
Practice Address - Country:US
Practice Address - Phone:262-474-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant