Healthcare Provider Details

I. General information

NPI: 1639358914
Provider Name (Legal Business Name): MOLLY JEAN GRANT RN, MSN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 N OAK PARK AVE SHRINERS HOSPITAL
CHICAGO IL
60707-3351
US

IV. Provider business mailing address

2211 N OAK PARK AVE SHRINERS HOSPITAL
CHICAGO IL
60707-3351
US

V. Phone/Fax

Practice location:
  • Phone: 773-385-5804
  • Fax: 773-385-5488
Mailing address:
  • Phone: 773-385-5804
  • Fax: 773-385-5488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209003801
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: