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Organization
TA GRANT WELLNESS
Active
Organization
TA GRANT WELLNESS
Active
Other names
TA GRANT WELLNESS
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TITILAYO GRANT NP (NURSE PRACTITIONER/MANAGER)
(520) 233-4585
Entity
Organization
Contact information
Practice address
3015 S BELL PL, CHANDLER, AZ 85286-2496
(520) 233-4585
Mailing address
3015 S BELL PL, CHANDLER, AZ 85286-2496
(520) 233-4585
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134698566
—
AZ
Enumeration date
11/21/2020
Last updated
11/21/2020
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