MEDICARE: MRS. PLESHETTE GRANT RN, BSN

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	163WC1500X	Community Health Registered Nurse	52613	SC

General Provider Information

NPI Number	:	1972084739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PLESHETTE GRANT RN, BSN

Provider Business Mailing Address
First Line	:	4739 LINFIELD LN
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29418-5014
Country	:	US
Telephone Number	:	843-345-0555
Fax Number	:

Provider Business Practice Location Address
First Line	:	4739 LINFIELD LN
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29418-5014
Country	:	US
Telephone Number	:	843-345-0555
Fax Number	:

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

Provider Enumeration Date	:	08/28/2018
Last Update Date	:	08/28/2018

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