Healthcare Provider Details

I. General information

NPI: 1497994008
Provider Name (Legal Business Name): JEANOLIVIA DEAN GRANT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2009
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LOWER NAVY HILL
SAIPAN MP
96950-0409
US

IV. Provider business mailing address

P.O. BOX 500409
SAIPAN MP
96950-0409
US

V. Phone/Fax

Practice location:
  • Phone: 670-234-8950
  • Fax:
Mailing address:
  • Phone: 670-234-8950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number468
License Number StateMP
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.17134
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: