Individual
MRS. PAULETTE KATHLEEN GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.C.
Contact information
Practice address
112 INDEPENDENCE WAY STE 110, CLYDE, OH 43410-9812
(419) 483-9000
(419) 483-9003
Mailing address
PO BOX 378, SANDUSKY, OH 44871-0378
(419) 609-1112
(419) 502-3537
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
50-00-0434
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50-00-0434
PHYSICIAN ASSISTANT REG
OH
Enumeration date
06/29/2006
Last updated
09/21/2018
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