Individual
JANIE MAE GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1465 LAKELAND DR, JACKSON, MS 39216-4719
(769) 777-1058
Mailing address
1465 LAKELAND DR, JACKSON, MS 39216-4719
(769) 777-1058
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R878313
MS
Other
Enumeration date
06/30/2016
Last updated
06/30/2016
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