1154694065 NPI number — MRS. JEANETTE M GRANT DNP, FNP-BC

Table of content: MRS. JEANETTE M GRANT DNP, FNP-BC (NPI 1154694065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154694065 NPI number — MRS. JEANETTE M GRANT DNP, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRANT
Provider First Name:
JEANETTE
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DNP, FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SESSOMS
Provider Other First Name:
JEANETTE
Provider Other Middle Name:
MISSOURI
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DNP, FNP-BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154694065
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 RAWLINS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEAFORD
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19973-5881
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-990-3300
Provider Business Mailing Address Fax Number:
302-990-3300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21444 CARMEAN WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19947-4572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-855-1233
Provider Business Practice Location Address Fax Number:
302-855-2025
Provider Enumeration Date:
02/23/2012

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:  0024169918 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: LG-0012313 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1154694065 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com