1013548650 NPI number — VOLHA A GRANT FNP

Table of content: VOLHA A GRANT FNP (NPI 1013548650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013548650 NPI number — VOLHA A GRANT FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRANT
Provider First Name:
VOLHA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013548650
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7291
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISTON
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04243-7291
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-777-8950
Provider Business Mailing Address Fax Number:
207-777-8800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
57 BIRCH ST STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISTON
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04240-7415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-753-5400
Provider Business Practice Location Address Fax Number:
207-786-0489
Provider Enumeration Date:
02/03/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  CNP191071 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)