MEDICARE: MRS. JULIAN GRANT RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	289605	NY
2	163W00000X	Registered Nurse	620151	NY

General Provider Information

NPI Number	:	1437338597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIAN GRANT RN

Provider Business Mailing Address
First Line	:	362 AVERY ST
Second Line	:
City	:	SOUTH WINDSOR
State	:	CT
Zip	:	06074-3002
Country	:	US
Telephone Number	:	914-426-6302
Fax Number	:

Provider Business Practice Location Address
First Line	:	362 AVERY ST
Second Line	:
City	:	SOUTH WINDSOR
State	:	CT
Zip	:	06074-3002
Country	:	US
Telephone Number	:	914-426-6302
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2007
Last Update Date	:	12/13/2021

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