MEDICARE: PHEBE JOY GRANDERSON CNM

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	367A00000X	Advanced Practice Midwife	M002138	AR
2	367A00000X	Advanced Practice Midwife	M115216	OK

General Provider Information

NPI Number	:	1760030027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHEBE JOY GRANDERSON CNM

Provider Business Mailing Address
First Line	:	214 S 1ST ST STE 203
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72756-4504
Country	:	US
Telephone Number	:	479-935-3392
Fax Number	:	866-441-1301

Provider Business Practice Location Address
First Line	:	214 S 1ST ST STE 203
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72756-4504
Country	:	US
Telephone Number	:	479-935-3392
Fax Number	:	866-441-1301

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

Provider Enumeration Date	:	08/29/2019
Last Update Date	:	01/05/2024

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