Individual
JACQUELINE GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1900 N WHITE SANDS BLVD, ALAMOGORDO, NM 88310-6246
(575) 437-3505
(575) 439-4494
Mailing address
1900 N WHITE SANDS BLVD, ALAMOGORDO, NM 88310-6246
(575) 437-3505
(575) 439-4494
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN-22860
NM
Other
Enumeration date
09/13/2016
Last updated
09/13/2016
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