Individual
MRS. ROBERTA ANN GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP C
Contact information
Practice address
100 JOHN ROEMMELT DR STE 204, HORSEHEADS, NY 14845-8304
(607) 795-2828
(607) 795-2829
Mailing address
571 SAINT JOSEPHS BLVD FL 2, ELMIRA, NY 14901-3230
(607) 271-2050
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
F3347761
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02850613
—
NY
Enumeration date
10/10/2006
Last updated
11/24/2020
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