Individual
JESSICA GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
312 OLIVE ST, JOHNSTOWN, PA 15905-2700
(814) 254-8709
Mailing address
312 OLIVE ST, JOHNSTOWN, PA 15905-2700
(814) 254-8709
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN316108
PA
Other
Enumeration date
08/26/2022
Last updated
08/26/2022
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