Individual
VENETREA LAWANDA GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9165 OTIS AVE STE 222, INDIANAPOLIS, IN 46216-2316
(317) 331-7068
(317) 723-3772
Mailing address
9165 OTIS AVE STE 222, INDIANAPOLIS, IN 46216-2316
(317) 331-7068
(317) 723-3772
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
170140631
IN
3747P1801X
Personal Care Attendant
170140631
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300009906
—
IN
05
—
813743408
—
IN
Enumeration date
01/31/2018
Last updated
06/16/2018
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