Individual
LONNIE MIKE GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
102 S BROUGHTON ST APT 106, WALTHILL, NE 68067-5150
(402) 922-3671
Mailing address
121 CENTENNIAL ST, WALTHILL, NE 68067-5090
(402) 846-5660
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
—
Other
Enumeration date
02/26/2025
Last updated
02/26/2025
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