1518124445 NPI number — MEGGAN JUSTINE GRANT-NIERMAN DO

Table of content: MEGGAN JUSTINE GRANT-NIERMAN DO (NPI 1518124445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518124445 NPI number — MEGGAN JUSTINE GRANT-NIERMAN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRANT-NIERMAN
Provider First Name:
MEGGAN
Provider Middle Name:
JUSTINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRANT
Provider Other First Name:
MEGGAN
Provider Other Middle Name:
JUSTINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518124445
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 OLD STAGE RD UNIT A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALIDA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81201-8942
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-867-6330
Provider Business Mailing Address Fax Number:
719-785-0530

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 OLD STAGE RD UNIT A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALIDA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81201-8942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-867-6330
Provider Business Practice Location Address Fax Number:
719-785-0530
Provider Enumeration Date:
05/19/2008

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: 207Q00000X , with the licence number:  6951 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 51137 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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