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General NPI Number Information
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NPI Number | 1912402777
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Entity Type | Individual
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Provider Name | DENISE GRANT CRNP AC PEDIATRICS
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Gender | Female
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 03/26/2018
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Provider Practice Location Address
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Address Line | 301 HOSPITAL DR
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City | GLEN BURNIE
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State | MD
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Zip | 21061-5803
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Country | US
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Telephone | 410-787-4273
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Fax |
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Provider Business Mailing Address
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Address Line | 1911 OAKLEY RD
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City | GLEN BURNIE
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State | MD
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Zip | 21061-4319
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Country | US
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Telephone | 443-804-8882
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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 | 363LP0222X
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Taxonomy Name | Critical Care Pediatric Nurse Practitioner
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License Number | R113037
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License Number State | MD
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