=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154694065
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEANETTE M GRANT DNP, FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2012
-----------------------------------------------------
Last Update Date | 09/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21444 CARMEAN WAY
-----------------------------------------------------
City | GEORGETOWN
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19947-4572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-855-1233
-----------------------------------------------------
Fax | 302-855-2025
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 RAWLINS DR
-----------------------------------------------------
City | SEAFORD
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19973-5881
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-990-3300
-----------------------------------------------------
Fax | 302-990-3300
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 0024169918
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | LG-0012313
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------