Individual
STEPHEN GRANTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
39 RIDGEWOOD LOOP, VILONIA, AR 72173-8058
(501) 912-6884
Mailing address
39 RIDGEWOOD LOOP, VILONIA, AR 72173-8058
(501) 912-6884
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R095593
AR
Other
Enumeration date
02/17/2016
Last updated
02/17/2016
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