Healthcare Provider Details

I. General information

NPI: 1558418608
Provider Name (Legal Business Name): DONALD F GRANT LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 INDIAN HILLS DR
MACY NE
68039
US

IV. Provider business mailing address

100 INDIAN HILLS DR
MACY NE
68039
US

V. Phone/Fax

Practice location:
  • Phone: 402-837-4053
  • Fax: 402-837-5303
Mailing address:
  • Phone: 402-837-4053
  • Fax: 402-837-5303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: