Healthcare Provider Details

I. General information

NPI: 1952025371
Provider Name (Legal Business Name): ALFRED JAMES GRANT IV RN, BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 SHIPLEY RD
WILMINGTON DE
19803-2306
US

IV. Provider business mailing address

1402 VEALE RD
WILMINGTON DE
19810-4332
US

V. Phone/Fax

Practice location:
  • Phone: 302-479-1623
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberL1-0041760
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: