Individual
KHAIRUNISSIA MEICHELLE GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3031 W GRAND BLVD, DETROIT, MI 48202-3046
(313) 916-2454
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(313) 874-4806
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4704267384
MI
363LF0000X
Family Nurse Practitioner
Primary
4704267384
MI
Other
Enumeration date
11/12/2025
Last updated
06/22/2026
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