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General NPI Number Information
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NPI Number | 1457475170
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Entity Type | Individual
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Provider Name | WINSOME LEONIE GRANT PH.D., NP
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 163 W 125TH ST 4TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10027-4436
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Country | US
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Telephone | 212-531-8011
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Fax | 212-749-1375
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Provider Business Mailing Address
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Address Line | 50 COLUMBUS AVE TOWNHOUSE C 10
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City | TUCKAHOE
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State | NY
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Zip | 10707-2527
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Country | US
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Telephone | 914-961-3738
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 330629
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License Number State | NY
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