MEDICARE: DR. WINSOME LEONIE GRANT PH.D., NP

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	330629	NY

General Provider Information

NPI Number	:	1457475170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WINSOME LEONIE GRANT PH.D., NP

Provider Business Mailing Address
First Line	:	50 COLUMBUS AVE
Second Line	:	TOWNHOUSE C 10
City	:	TUCKAHOE
State	:	NY
Zip	:	10707-2527
Country	:	US
Telephone Number	:	914-961-3738
Fax Number	:

Provider Business Practice Location Address
First Line	:	163 W 125TH ST
Second Line	:	4TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10027-4436
Country	:	US
Telephone Number	:	212-531-8011
Fax Number	:	212-749-1375

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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