Individual
MISS CHARLENE GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
4713 CHURCH AVE, BROOKLYN, NY 11203-3209
(718) 284-7070
Mailing address
61 ARLO RD, STATEN ISLAND, NY 10301-4724
(718) 730-5224
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
F345680-01
NY
Other
Enumeration date
03/19/2020
Last updated
04/05/2021
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