Healthcare Provider Details

I. General information

NPI: 1902007198
Provider Name (Legal Business Name): NICOLE NILMEIER GRANT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 MIRANDA AVE
PALO ALTO CA
94304-1290
US

IV. Provider business mailing address

4022 BRISTOL RD
DURHAM NC
27707-5403
US

V. Phone/Fax

Practice location:
  • Phone: 650-493-5000
  • Fax: 919-383-6128
Mailing address:
  • Phone: 199-430-2229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License NumberC139028
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2007-00058
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: