Individual
NICKESHIA GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
26 FOREST RIDGE RD, WATERBURY, CT 06708-1810
(914) 572-8683
Mailing address
26 FOREST RIDGE RD, WATERBURY, CT 06708-1810
(914) 572-8683
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
320155
NY
Other
Enumeration date
09/24/2024
Last updated
09/24/2024
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