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Individual

CAROLINA GRANT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RDN

Contact information

Practice address
4131 N 24TH ST STE B102, PHOENIX, AZ 85016-6231
(480) 882-4545
Mailing address
7500 N DREAMY DRAW DR STE 145, PHOENIX, AZ 85020-4668
(480) 882-4545
(480) 882-5814

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86106922
AZ
174N00000X
Lactation Consultant (Non-RN)
L-305659

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
150093
AZ
Enumeration date
08/04/2022
Last updated
12/30/2022
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