Healthcare Provider Details

I. General information

NPI: 1982086351
Provider Name (Legal Business Name): EDRINA CHARLURA GRANT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 HOSPICE CIR
RALEIGH NC
27607-6372
US

IV. Provider business mailing address

250 HOSPICE CIR
RALEIGH NC
27607-6372
US

V. Phone/Fax

Practice location:
  • Phone: 919-828-0890
  • Fax:
Mailing address:
  • Phone: 919-828-0890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5007691
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: