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NPI Code Detail

MEDICARE: WENDY GRANT

MEDICARE: WENDY GRANT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1175T00000XPeer Specialist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093119836
Entity Type Code : Individual
Provider Name (Legal Business Name) : WENDY GRANT
Provider Business Mailing Address
First Line : 1711 WHITNEY MESA DR
Second Line :
City : HENDERSON
State : NV
Zip : 89014-2080
Country : US
Telephone Number : 702-385-2020
Fax Number : 702-658-6608
Provider Business Practice Location Address
First Line : 323 N MARYLAND PKWY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89101-3130
Country : US
Telephone Number : 702-385-3330
Fax Number : 702-207-7155
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2014
Last Update Date : 12/13/2017

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