Individual
STEPHANIE GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
20 A L CORBETT CIRCLE, WAGENER, SC 29164
(803) 564-1000
Mailing address
20 A L CORBETT CIRCLE, WAGENER, SC 29164
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
97233
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163WA200X
—
SC
Enumeration date
01/16/2014
Last updated
01/16/2014
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