Individual
CHARLES GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1000 HEALTH CENTER DR, MATTOON, IL 61938-9261
(217) 258-2525
(217) 258-4175
Mailing address
2221 ELM ST, RAWLINS, WY 82301-5108
(307) 324-2221
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
209-014807
IL
367500000X
Certified Registered Nurse Anesthetist
28240666A
IN
367500000X
Certified Registered Nurse Anesthetist
Primary
42034.1850
WY
Other
Enumeration date
09/14/2016
Last updated
01/29/2019
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