Healthcare Provider Details

I. General information

NPI: 1336086727
Provider Name (Legal Business Name): VICTORIA L GRANT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 E MOUNT ROYAL AVE STE PH
BALTIMORE MD
21202-2714
US

IV. Provider business mailing address

11 E MOUNT ROYAL AVE STE PH
BALTIMORE MD
21202-2714
US

V. Phone/Fax

Practice location:
  • Phone: 410-888-0440
  • Fax: 443-378-7005
Mailing address:
  • Phone: 410-888-0440
  • Fax: 443-378-7005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN091752
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: