Individual
MARY E GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
10140 SW PARKWAY, PORTLAND, OR 97225-5008
(503) 215-2669
Mailing address
P.O. BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
077037862N3
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128111
—
OR
Enumeration date
08/19/2005
Last updated
02/12/2021
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