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NPI Code Detail

MEDICARE: JOELENE GRANDY

MEDICARE:   JOELENE  GRANDY
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
1171W00000XContractor

General Provider Information

NPI Number : 1336679349
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOELENE GRANDY
Provider Business Mailing Address
First Line : 1892 RIVER ROCK ARCH
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23456-6164
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1892 RIVERROCK ARCH
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23456
Country : US
Telephone Number : 757-471-2113
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2017
Last Update Date : 06/13/2017

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Directions to “ JOELENE GRANDY ” Practice Location

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