Healthcare Provider Details

I. General information

NPI: 1831741503
Provider Name (Legal Business Name): BLAIR ALEXANDRIA GRANT MSN, APRN-RX, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2547 10TH AVE
HONOLULU HI
96816-3030
US

IV. Provider business mailing address

2547 10TH AVE
HONOLULU HI
96816-3030
US

V. Phone/Fax

Practice location:
  • Phone: 808-391-7776
  • Fax:
Mailing address:
  • Phone: 808-391-7776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-74495
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2833
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2833
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: