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General NPI Number Information
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NPI Number | 1275756751
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Entity Type | Individual
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Provider Name | DEANNA GRANDSTAFF PA
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Gender | Female
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3900 JOE RAMSEY BLVD E BLDG #7
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City | GREENVILLE
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State | TX
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Zip | 75401-7727
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Country | US
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Telephone | 903-455-5654
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Fax |
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Provider Business Mailing Address
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Address Line | 109 SAINT MARY ST
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City | ROCKWALL
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State | TX
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Zip | 75087-4017
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA03256
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License Number State | TX
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