MEDICARE: MRS. JOYLYN MARIE GRANT 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	0024165962	VA

General Provider Information

NPI Number	:	1962404277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOYLYN MARIE GRANT NP

Provider Business Mailing Address
First Line	:	13041 MONTEREY ESTATES DR
Second Line	:
City	:	HERNDON
State	:	VA
Zip	:	20171-2638
Country	:	US
Telephone Number	:	703-326-0858
Fax Number	:

Provider Business Practice Location Address
First Line	:	2616 SHERWOOD HALL LN
Second Line	:	STE 203
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-3154
Country	:	US
Telephone Number	:	703-360-0594
Fax Number	:

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/08/2007

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