Individual
MS. MARY L GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
912 KARL ST, GREEN BAY, WI 54301-2225
(920) 432-1014
Mailing address
912 KARL ST, GREEN BAY, WI 54301
(920) 432-1014
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
9450730
WI
163WH0200X
Home Health Registered Nurse
9450730
WI
163WH1000X
Hospice Registered Nurse
9450730
WI
Other
Enumeration date
05/10/2010
Last updated
05/10/2010
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