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Individual

MS. WANDA JEAN GRANT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
REGISTERED NURSE

Contact information

Practice address
117 N B ST, LOMPOC, CA 93436-6901
(805) 681-5100
Mailing address
43036 30TH ST W APT 131, LANCASTER, CA 93536-4773
(661) 481-1121

Taxonomy

Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
348078
CA

Other

Enumeration date
05/01/2019
Last updated
05/01/2019
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