Individual
MR. GRANT PENN CHANIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CNP
Contact information
Practice address
1100 CENTRAL AVE SE, ALBUQUERQUE, NM 87106-4930
(505) 841-1125
(505) 841-1737
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
CNP-02952
NM
Other
Enumeration date
06/13/2016
Last updated
01/27/2025
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