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General NPI Number Information
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NPI Number | 1245679463
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Entity Type | Individual
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Provider Name | JENNIFER GRANT DNP, PMHNP, RN, LMT
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Gender | Female
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Dates
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Enumeration Date | 06/20/2013
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 2110 MISSION ST SE STE 305
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City | SALEM
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State | OR
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Zip | 97302-0038
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Country | US
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Telephone | 503-379-1902
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Fax |
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Provider Business Mailing Address
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Address Line | 5301 SW TAYLORS FERRY RD
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City | PORTLAND
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State | OR
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Zip | 97219-5879
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Country | US
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Telephone | 503-313-8888
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | TBD
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 202009213RN
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 19165
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License Number State | OR
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