Healthcare Provider Details

I. General information

NPI: 1881979532
Provider Name (Legal Business Name): KAREN GRANT MEDICAL ASSISTANT/CE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 SOUTH WALTER REED DRIVE SUITE 462A
ARLINGTON VA
22204
US

IV. Provider business mailing address

627 SOUTH WALTER REED DRIVE SUITE 462A
ARLINGTON VA
22204
US

V. Phone/Fax

Practice location:
  • Phone: 571-236-4360
  • Fax:
Mailing address:
  • Phone: 571-236-4360
  • Fax: 571-236-4360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberNA00604623
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number1401133273
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number255863
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNA00604623
License Number StateDC
# 5
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number1401133272
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number255863
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: