Individual
MR. WAYNE KEITH GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
1090 GOAT SPRINGS RD, TAOS PUEBLO, NM 87571
(505) 758-4224
(505) 751-5210
Mailing address
PO BOX 1956, 1090 GOAT SPRINGS RD, TAOS PUEBLO, NM 87571
(505) 758-4224
(505) 751-5210
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN961075
DC
Other
Enumeration date
06/14/2013
Last updated
08/16/2013
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