MEDICARE: MS. IESHA ISHEA GRANT APRN-BC

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	363LF0000X	Family Nurse Practitioner	688501	TX

General Provider Information

NPI Number	:	1275709412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IESHA ISHEA GRANT APRN-BC

Provider Business Mailing Address
First Line	:	2501 DALLAS ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77003-3605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 DALLAS ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77003-3605
Country	:	US
Telephone Number	:	713-222-2448
Fax Number	:

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

Provider Enumeration Date	:	05/07/2008
Last Update Date	:	05/07/2008

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