Healthcare Provider Details

I. General information

NPI: 1245505882
Provider Name (Legal Business Name): GEORGIA LOUISE GRANT N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 EAST 47TH AVENUE DRIVE SUITE 100
DENVER CO
80216-3449
US

IV. Provider business mailing address

6900 EAST 47TH AVENUE DRIVE SUITE 100
DENVER CO
80216-3449
US

V. Phone/Fax

Practice location:
  • Phone: 303-333-4411
  • Fax: 303-333-8719
Mailing address:
  • Phone: 303-333-4411
  • Fax: 303-333-8719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number27726
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: