Individual
SHIRLEY GRANDISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
307 E FLORENCE ST, HATTIESBURG, MS 39401-6443
(850) 316-5749
Mailing address
307 E FLORENCE ST, HATTIESBURG, MS 39401-6443
(850) 316-5749
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A036266
MISSISSIPPI HEALTH BOARD
MS
Enumeration date
06/29/2020
Last updated
06/29/2020
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