Individual
RENEE GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
885 W CONNEXION WAY STE 200, COLUMBIA CITY, IN 46725-1045
(260) 248-9260
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28159409A
IN
363L00000X
Nurse Practitioner
Primary
71008867A
IN
363L00000X
Nurse Practitioner
APRN.CNP.0037843
OH
Other
Enumeration date
01/15/2019
Last updated
11/25/2024
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