Healthcare Provider Details

I. General information

NPI: 1902769854
Provider Name (Legal Business Name): AUNDREA LOUISE GRANT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 ROSEVILLE PKWY APT 2215
ROSEVILLE CA
95747-4163
US

IV. Provider business mailing address

350 ROSEVILLE PKWY APT 2215
ROSEVILLE CA
95747-4163
US

V. Phone/Fax

Practice location:
  • Phone: 530-906-1554
  • Fax:
Mailing address:
  • Phone: 530-906-1554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95037707
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: