Healthcare Provider Details

I. General information

NPI: 1770606527
Provider Name (Legal Business Name): JUDITH L. GRANT ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 LOWER CAMPUS DR ALFRED STATE COLLEGE HEALTH SERVICES
ALFRED NY
14802-1196
US

IV. Provider business mailing address

10 LOWER CAMPUS DR ALFRED STATE COLLEGE HEALTH SERVICES
ALFRED NY
14802-1196
US

V. Phone/Fax

Practice location:
  • Phone: 607-587-4200
  • Fax: 607-587-4203
Mailing address:
  • Phone: 607-587-4200
  • Fax: 607-587-4203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF300630-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: