MEDICARE: GRACE ECKFORD GRANTIER CRNP

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	363LF0000X	Family Nurse Practitioner	1-180989	AL

General Provider Information

NPI Number	:	1538776281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE ECKFORD GRANTIER CRNP

Provider Business Mailing Address
First Line	:	2511 ALTADENA FOREST CIR
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35243-4618
Country	:	US
Telephone Number	:	601-408-1009
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 HIGHWAY 280 S STE 212
Second Line	:
City	:	MOUNTAIN BRK
State	:	AL
Zip	:	35223-2468
Country	:	US
Telephone Number	:	205-878-4368
Fax Number	:

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

Provider Enumeration Date	:	09/27/2020
Last Update Date	:	09/27/2020

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