Individual
AUSTIN GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
205 JOPLIN ST, BENTON, IL 62812-2023
(618) 603-6209
Mailing address
205 JOPLIN ST, BENTON, IL 62812-2023
(618) 603-6209
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043.129163
IL
Other
Enumeration date
08/24/2020
Last updated
08/24/2020
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