MEDICARE: CHRISTOPHER 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
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1114402633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER GRANT

Provider Business Mailing Address
First Line	:	6408 PEPPERMILL DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-0801
Country	:	US
Telephone Number	:	702-278-2778
Fax Number	:

Provider Business Practice Location Address
First Line	:	5446 BOULDER HWY # G3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-6069
Country	:	US
Telephone Number	:	702-291-7121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2018
Last Update Date	:	10/01/2018

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