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NPI Code Detail

MEDICARE: MRS. GEORGIA LOUISE GRANT N.P.

MEDICARE: MRS. GEORGIA LOUISE GRANT N.P.
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
1363LA2200XAdult Health Nurse Practitioner27726CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
127726OTHERCOLICENSE

General Provider Information

NPI Number : 1245505882
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GEORGIA LOUISE GRANT N.P.
Provider Business Mailing Address
First Line : 6900 EAST 47TH AVENUE DRIVE
Second Line : SUITE 100
City : DENVER
State : CO
Zip : 80216-3449
Country : US
Telephone Number : 303-333-4411
Fax Number : 303-333-8719
Provider Business Practice Location Address
First Line : 6900 EAST 47TH AVENUE DRIVE
Second Line : SUITE 100
City : DENVER
State : CO
Zip : 80216-3449
Country : US
Telephone Number : 303-333-4411
Fax Number : 303-333-8719
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2012
Last Update Date : 03/15/2012

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